Abstract
Radiotherapy (RT) is the standard of care following breast-conserving operation in breast cancer patients. The neutrophil-to-lymphocyte ratio (NLR) reflects the systemic change caused as a result of the radiotherapy. We aimed to evaluate the association between RT and the change in NLR following the receipt of RT, and to investigate the prognostic impact. We retrospectively reviewed NLR values of breast cancer patients taken before the administration of the first and the last session of RT. The cut-off point for the NLR was determined using the Youden index and receiver operating characteristic (ROC) curve within the training set. Recurrence-free survival (RFS), distant metastasis free survival, and overall survival were the main outcomes. Patients with an NLR higher than 3.49 after RT were classified to an RT-induced high NLR group and showed a significantly higher recurrence rate compared to those with low NLR (p < 0.001). In a multivariate Cox proportional hazards model, RT-induced high NLR remained a significant prognostic factor (HR 2.194, 95% CI 1.230–3.912, p = 0.008 for tumor recurrence. We demonstrated that an increase in NLR over the course of RT has a negative impact on survival, putting these patients with RT-susceptible host immunity at a higher risk of tumor recurrence.
Highlights
The tumor immune environment plays an important role in tumor progression by promoting angiogenesis, metastasis, proliferation, and by interfering with the response to systemic treatment [1,2,3].Neutrophils and lymphocytes play a crucial role in tumor inflammation [4]
Previous studies have indicated that a high neutrophil-to-lymphocyte ratio (NLR) reflects an abnormal host-immune surveillance status, which might significantly contribute to tumor proliferation, invasion, and metastasis [10,11]
Many previous studies have consistently demonstrated that high NLR is associated with poor survival in patients diagnosed with various solid cancers [7,8,9,12,13,14,15,19]
Summary
The tumor immune environment plays an important role in tumor progression by promoting angiogenesis, metastasis, proliferation, and by interfering with the response to systemic treatment [1,2,3].Neutrophils and lymphocytes play a crucial role in tumor inflammation [4]. The tumor immune environment plays an important role in tumor progression by promoting angiogenesis, metastasis, proliferation, and by interfering with the response to systemic treatment [1,2,3]. The neutrophil-to-lymphocyte ratio (NLR), which represents the ratio of the peripheral circulating neutrophil and lymphocyte count, reflects the imbalance between immune surveillance and tumor progression [5,6,7,8,9]. Previous studies have indicated that a high NLR reflects an abnormal host-immune surveillance status, which might significantly contribute to tumor proliferation, invasion, and metastasis [10,11]. Cancers 2020, 12, x prognostic biomarker for several types of cancers, including colorectal, breast, and lung [12,13,14,15,16,17,18,19].
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