The Peripheral Blood Neutrophil-To-Lymphocyte Ratio Is Superior to the Lymphocyte-To-Monocyte Ratio for Predicting the Long-Term Survival of Triple-Negative Breast Cancer Patients.

Weijuan Jia,Xiaolan Zhang,Kai Chen,Fengxi Su,Yaping Yang,Jiannan Wu,Haixia Jia

doi:10.1371/journal.pone.0143061

Abstract

PurposeThe peripheral hematologic parameters of patients can be prognostic for many malignant tumors, including breast cancer, although their value has not been investigated among the different molecular subtypes of breast cancer. The purpose of this study was to examine the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) in different molecular subtypes of breast cancer.MethodsA retrospective cohort of 1570 operable breast cancer patients was recruited between January 2000 and December 2010. The counts of peripheral neutrophils, lymphocytes, monocytes and platelets were collected and applied to calculate the NLR and the LMR. Univariate and multivariate Cox proportional hazard analyses were used to assess the relationship of the NLR and the LMR with disease-free survival (DFS) and overall survival (OS) in all patients and triple negative breast cancer (TNBC) patients.ResultsUnivariate analysis revealed that lower NLR (≤2.0) and higher LMR (>4.8) were significantly associated with superior DFS in all patients (NLR, P = 0.005; LMR, P = 0.041) and in TNBC patients (NLR, p = 0.007; LMR, P = 0.011). However, multivariate analysis revealed that only lower NLR was a significant independent predictor of superior DFS and OS in all breast cancer patients (DFS, HR = 1.50 95% CI: 1.14–1.97, P = 0.004; OS, HR = 1.63, 95% CI: 1.07–2.49, P = 0.022) and in TNBC patients (DFS, HR = 2.58, 95% CI: 1.23–5.42, P = 0.012; OS, HR = 3.05, 95% CI: 1.08–8.61, P = 0.035). Both univariate and multivariate analysis revealed that neither the NLR nor the LMR significantly predicted DFS and OS among the patients with other molecular subtypes of breast cancer.ConclusionsA higher pretreatment peripheral NLR significantly and independently indicated a poor prognosis for breast cancer and TNBC, and this measurement exhibited greater prognostic value than a lower LMR. The NLR was not a prognostic factor for other breast cancer subtypes.

Highlights

Breast cancer is currently the most common cancer among women, and the incidence of breast cancer increases yearly in China
Univariate analysis revealed that lower neutrophil-to-lymphocyte ratio (NLR) ( 2.0) and higher lymphocyte-tomonocyte ratio (LMR) (>4.8) were significantly associated with superior disease-free survival (DFS) in all patients (NLR, P = 0.005; LMR, P = 0.041) and in triple negative breast cancer (TNBC) patients (NLR, p = 0.007; LMR, P = 0.011)
Multivariate analysis revealed that only lower NLR was a significant independent predictor of superior DFS and overall survival (OS) in all breast cancer patients

Summary

Introduction

Breast cancer is currently the most common cancer among women, and the incidence of breast cancer increases yearly in China. Breast cancer mortality rates have decreased worldwide in recent decades due to improvements in cancer treatment, breast cancer remains one of the leading causes of cancer death among females [1,2]. It is widely realized that the prognosis of cancer patients depends on both tumor characteristics and patient-related factors. Many studies have focused on inflammation and determined that cancer-related inflammation plays an important role in the development and prognosis of cancer. The host response in systemic inflammation has been considered an independent prognosis factor of cancer patients [4]. It is easy to determine the severity of the systemic inflammatory response in patients with cancer via this simple test [5]

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