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Wang H, Huang Z, Xu B, Zhang J, He P, Gao F, Zhang R, Huang X, Shan M. The predictive value of systemic immune-inflammatory markers before and after treatment for pathological complete response in patients undergoing neoadjuvant therapy for breast cancer: a retrospective study of 1994 patients. Clin Transl Oncol 2024; 26:1467-1479. [PMID: 38190034 DOI: 10.1007/s12094-023-03371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Systemic immune-inflammatory markers have a certain predictive role in pathological complete response (pCR) after neoadjuvant treatment (NAT) in breast cancer. However, there is a lack of research exploring the predictive value of markers after treatment. METHODS This retrospective study collected data from 1994 breast cancer patients who underwent NAT. Relevant clinical and pathological characteristics were included, and pre- and post-treatment complete blood cell counts were evaluated to calculate four systemic immune-inflammatory markers: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII). The optimal cutoff values for these markers were determined using ROC curves, and patients were classified into high-value and low-value groups based on these cutoff values. Univariate and multivariate logistic regression analyses were conducted to analyze factors influencing pCR. The factors with independent predictive value were used to construct a nomogram. RESULTS After NAT, 383 (19.2%) patients achieved pCR. The area under the ROC curve is generally larger for post-treatment markers compared to pre-treatment markers. Pre-treatment NLR and PLR, as well as post-treatment LMR and SII, were identified as independent predictive factors for pCR, along with Ki-67, clinical tumor stage, clinical lymph node stage, molecular subtype, and clinical response. Higher pre-NLR (OR = 1.320; 95% CI 1.016-1.716; P = 0.038), pre-PLR (OR = 1.474; 95% CI 1.058-2.052; P = 0.022), post-LMR (OR = 1.532; 95% CI 1.175-1.996; P = 0.002), and lower post-SII (OR = 0.596; 95% CI 0.429-0.827; P = 0.002) are associated with a higher likelihood of achieving pCR. The established nomogram had a good predictive performance with an area under the ROC curve of 0.754 (95% CI 0.674-0.835). CONCLUSION Both pre- and post-treatment systemic immune-inflammatory markers have a significant predictive role in achieving pCR after NAT in breast cancer patients. Indeed, it is possible that post-treatment markers have stronger predictive ability compared to pre-treatment markers.
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Affiliation(s)
- Huibo Wang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Zhenfeng Huang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Bingqi Xu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Jinxing Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Pengfei He
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Fei Gao
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Ruifeng Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Xiatian Huang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Ming Shan
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, China.
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Dowling GP, Daly GR, Hegarty A, Hembrecht S, Bracken A, Toomey S, Hennessy BT, Hill ADK. Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis. Br J Surg 2024; 111:znae132. [PMID: 38801441 PMCID: PMC11129713 DOI: 10.1093/bjs/znae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting the response to neoadjuvant chemotherapy in breast cancer is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this. METHODS A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer before commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pCR rates in relation to the inflammatory marker. Outcome data are reported as ORs and 95% confidence intervals. RESULTS A total of 49 studies were included, of which 42 were suitable for meta-analysis. A lower pretreatment neutrophil-to-lymphocyte ratio was associated with an increased pCR rate (pooled OR 1.66 (95% c.i. 1.32 to 2.09); P < 0.001). A lower white cell count (OR 1.96 (95% c.i. 1.29 to 2.97); P = 0.002) and a lower monocyte count (OR 3.20 (95% c.i. 1.71 to 5.97); P < 0.001) were also associated with a pCR. A higher lymphocyte count was associated with an increased pCR rate (OR 0.44 (95% c.i. 0.30 to 0.64); P < 0.001). CONCLUSION The present study found the pretreatment neutrophil-to-lymphocyte ratio, white cell count, lymphocyte count, and monocyte count of value in the prediction of a pCR in the neoadjuvant treatment of breast cancer. Further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, before their adoption in clinical practice.
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Affiliation(s)
- Gavin P Dowling
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gordon R Daly
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Sandra Hembrecht
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Aisling Bracken
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Zhou Y, Guo X, Shen L, Liu K, Sun Q, Wang Y, Wang H, Fu W, Yao Y, Wu S, Chen H, Qiu J, Pan T, Deng Y. Predictive Significance of Systemic Immune-Inflammation Index in Patients with Breast Cancer: A Retrospective Cohort Study. Onco Targets Ther 2023; 16:939-960. [PMID: 38021447 PMCID: PMC10658965 DOI: 10.2147/ott.s434193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Peripheral blood inflammation indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), have become research hotspots in the diagnosis, treatment, and prognosis prediction of breast cancer, whereas existing research findings remain controversial. Methods Data pertaining to 1808 breast cancer patients were collected retrospectively to analyze the predictive value of NLR/PLR/SII for breast cancer clinicopathological characteristics, chemotherapy response, and relapse. 1489, 258, and 53 eligible breast cancer patients entered into the three analyses, respectively. Logistic regression analyses were used to assess the correlation between these indices and poor response to chemotherapy. A predictive scoring model was established to predict chemotherapeutic responses based upon the odds ratio values of significant variables identified in logistic regression analyses. Results Higher pretherapeutic NLR/PLR/SII values were significantly correlated with higher tumor stage, triple-negative breast cancer, premenopausal status, and younger age. Logistic regression analyses indicated that pretherapeutic high SII (as a continuous variable or with a cut-off value of 586.40) and HER2-negative status were independent predictors of poor response to neoadjuvant chemotherapy. A first-in-class SII-based predictive scoring model well distinguished patients who might not benefit from neoadjuvant chemotherapy, with an area under the curve of 0.751. In HR-positive cancers, SII was more strongly associated with clinicopathological features and chemotherapy response. In addition, a receiver operating characteristic curve analysis indicated that the specificity of follow-up SII in identifying cancer relapse was greater than 98.0% at a cut-off value of 900. Conclusion As a predictor of breast cancer, especially in the HR-positive subtype, SII may eclipse NLR/PLR. SII-high patients are more likely to have a worse chemotherapy response and a higher risk of recurrence.
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Affiliation(s)
- Yunxiang Zhou
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xianan Guo
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lu Shen
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Kexin Liu
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Qunan Sun
- Department of Medical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yali Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China
| | - Hui Wang
- Department of Pathology, Cancer Hospital of the University of Chinese Academy of Science (Zhejiang Cancer Hospital), Hangzhou, People’s Republic of China
| | - Wenyu Fu
- Department of Surgery, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, People’s Republic of China
| | - Yihan Yao
- Institute of Immunology, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shijie Wu
- Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Huihui Chen
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jili Qiu
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Tao Pan
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yongchuan Deng
- Department of Breast Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Zhao M, Xing H, He J, Wang X, Liu Y. Tumor infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in relation to pathological complete remission to neoadjuvant therapy and prognosis in triple negative breast cancer. Pathol Res Pract 2023; 248:154687. [PMID: 37478522 DOI: 10.1016/j.prp.2023.154687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To explore the correlation between the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and tumor infiltrating lymphocyte (TIL) before neoadjuvant therapy (NAT) and the prognosis of patients with triple negative breast cancer. METHOD A total of 126 patients with TNBC who received NAT were screened out. TILs, CD8+TIL and FOXP3+TIL were detected by immunohistochemistry in core needle biopsy specimens before treatment, and NLR was calculated. Kaplan-Meier analysis was used to estimate survival rates. Univariate and multivariate analyses were performed using Cox proportional hazards regression. RESULTS NLR was negatively correlated with TILs density (p = 0.040) and FOXP3+ TIL was positively correlated with NLR (p = 0.019). Patients with low NLR/high TILs density showed the highest pCR rate (46/48, 95 %), while only 6/22 patients (21 %) with high NLR/low TILs density achieved pCR. Multivariate analysis showed that high NLR was independently associated with pCR ((HR = 5.043, 95 %CI = 1.637-15.535, p = 0.005). High T stage, lymph node involvement, lymphovascular invasion, high NLR, low TILs density and low CD8+ TIL were associated with poor OS and BCSS. Multivariate Cox regression analysis showed that high NLR (HR = 36.182, 95 %CI = 4.120-317.759, p = 0.001), high CD8+ TIL density (HR = 0.182, 95 %CI = 0.044-0.754, p = 0.019) were independently associated with poor OS. Similarly, high NLR (HR = 23.989, 95 %CI = 2.275-252.131, p = 0.008) was independently associated with worse BCSS. CONCLUSIONS NLR may help to screen the high-risk population of TNBC patients after neoadjuvant therapy.
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Affiliation(s)
- Meng Zhao
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hui Xing
- Cangzhou Integrated Traditional Chinese and Western Medicine Hospital, Cangzhou, Hebei, China
| | - Jiankun He
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinran Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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5
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Gao S, Tang W, Zuo B, Mulvihill L, Yu J, Yu Y. The predictive value of neutrophil-to-lymphocyte ratio for overall survival and pathological complete response in breast cancer patients receiving neoadjuvant chemotherapy. Front Oncol 2023; 12:1065606. [PMID: 36727046 PMCID: PMC9885149 DOI: 10.3389/fonc.2022.1065606] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/22/2022] [Indexed: 01/17/2023] Open
Abstract
Purpose Previous studies have reported that neutrophil-to-lymphocyte ratio (NLR) at pre-treatment was predictive for overall survival (OS) and pathologic complete response (pCR) in breast cancer (BC) patients receiving neoadjuvant chemotherapy (NAC). This study aims to explore the predictive role of both pre- and post-NLR for OS as well as longitudinal NLR kinetics towards pCR in BC patients undergoing NAC. Methods We retrospectively included 501 BC patients who received NAC from 2009 to 2018. NLR at pre-, mid (every two cycles of NAC)-, and post-treatment were collected. Overall, 421 patients were included in the survival analysis. These patients were randomly divided into a training cohort (n = 224) and a validation cohort (n = 197). A multivariable Cox model was built using all significant factors in the multivariable analysis from the training cohort. The performance of the model was verified in the validation cohort by the concordance index (C-index). Longitudinal analysis for pCR prediction of NLR was performed using a mixed-effects regression model among 176 patients who finished eight cycles of NAC. Results The median follow-up time was 43.2 months for 421 patients. In the training cohort, multivariable analysis revealed that ER status, clinical node stage, pCR, pre-NLR, and post-NLR (all p < 0.05) were independent predictors of OS. The OS nomogram was established based on these parameters. The C-indexes of the nomogram were 0.764 and 0.605 in the training and validation cohorts, respectively. In the longitudinal analysis, patients who failed to achieve pCR experienced an augment of NLR during NAC while NLR remained stable among patients with pCR. Pre-NLR tended to be significantly associated with OS in patients of HER2 overexpressing and TNBC subtypes (all p < 0.05), but not in Luminal A and Luminal B subtypes. Conclusions This study demonstrated the prognostic value of both pre-NLR and post-NLR on clinical outcomes in BC patients receiving NAC. A novel nomogram was established to predict OS. Non-pCR patients developed increased NLRs during NAC. Routine assessment of NLR may be a simple and affordable tool to predict prognosis for BC patients receiving NAC.
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Affiliation(s)
- Siming Gao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenjie Tang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Yishan Yu,
| | - Bingli Zuo
- Department of Clinical Epidemiology and Biostatistics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lianne Mulvihill
- Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yishan Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China,*Correspondence: Yishan Yu,
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Savioli F, Morrow ES, Dolan RD, Romics L, Lannigan A, Edwards J, McMillan DC. Prognostic role of preoperative circulating systemic inflammatory response markers in primary breast cancer: meta-analysis. Br J Surg 2022; 109:1206-1215. [PMID: 36130112 DOI: 10.1093/bjs/znac319] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Circulating markers of the systemic inflammatory response are prognostic in several cancers, but their role in operable breast cancer is unclear. A systematic review and meta-analysis of the literature was carried out. METHODS A search of electronic databases up to August 2020 identified studies that examined the prognostic value of preoperative circulating markers of the systemic inflammatory response in primary operable breast cancer. A meta-analysis was carried out for each marker with more than three studies, reporting a HR and 95 per cent confidence interval for disease-free survival (DFS), breast cancer-specific survival (BCSS) or overall survival (OS). RESULTS In total, 57 studies were reviewed and 42 were suitable for meta-analysis. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with worse overall survival (OS) (pooled HR 1.75, 95 per cent c.i. 1.52 to 2.00; P < 0.001), disease-free survival (DFS) (HR 1.67, 1.50 to 1.87; P < 0.001), and breast cancer-specific survival (BCSS) (HR 1.89, 1.35 to 2.63; P < 0.001). This effect was also seen with an arithmetically-derived NLR (dNLR). Higher platelet-to-lymphocyte ratio (PLR) was associated with worse OS (HR 1.29, 1.10 to 1.50; P = 0.001) and DFS (HR 1.58, 1.33 to 1.88; P < 0.001). Higher lymphocyte-to-monocyte ratio (LMR) was associated with improved DFS (HR 0.65, 0.51 to 0.82; P < 0.001), and higher C-reactive protein (CRP) level was associated with worse BCSS (HR 1.22, 1.07 to 1.39; P = 0.002) and OS (HR 1.24, 1.14 to 1.35; P = 0.002). CONCLUSION Current evidence suggests a role for preoperative NLR, dNLR, LMR, PLR, and CRP as prognostic markers in primary operable breast cancer. Further work should define their role in clinical practice, particularly reproducible thresholds and molecular subtypes for which these may be of most value.
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Affiliation(s)
- Francesca Savioli
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth S Morrow
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Laszlo Romics
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison Lannigan
- Department of Breast Surgery, University Hospital Wishaw, Wishaw, UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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7
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Dredze LM, Friger M, Ariad S, Koretz M, Delgado B, Shaco-Levy R, Tokar M, Bayme M, Agassi R, Rosenthal M, Dyomin V, Belochitski O, Libson S, Mizrahi T, Geffen DB. Neoadjuvant therapy with doxorubicin-cyclophosphamide followed by weekly paclitaxel in early breast cancer: a retrospective analysis of 200 consecutive patients treated in a single center with a median follow-up of 9.5 years. Breast Cancer Res Treat 2022; 193:597-612. [PMID: 35451732 DOI: 10.1007/s10549-022-06598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We analyzed outcomes of doxorubicin-cyclophosphamide (AC) followed by weekly paclitaxel as neoadjuvant chemotherapy (NAC) for breast cancer (BC), in an everyday practice with long-term follow-up of patients. METHODS All patients (n = 200) who received the AC-paclitaxel combination as NAC for BC at the Soroka University Medical Center from 2003 to 2012 were included in this retrospective cohort study. AC was administered on an every 3-week schedule (standard dose) until May, 2007 (n = 99); and subsequently every 2-week dose dense (dd) (n = 101). Clinical pathologic features, treatment course, and outcome information were recorded. Complete pathologic response (pCR) was analyzed according to BC subtype, dose regimen, and stage. RESULTS Median age was 49 years; 55.5% and 44.5% of patients were clinically stage 2 and 3, respectively. Standard dose patients had more T3 tumors. Subtypes were human epidermal growth factor receptor-2 (HER2)-positive 32.5% (of whom 82% received trastuzumab), hormone receptor-positive/HER2-negative 53%, and triple negative 14.5%. Breast-conserving surgery (BCS) was performed in 48.5% of patients; only 9.5% were deemed suitable for BCS prior to NAC. Toxicity was acceptable. The overall pCR rate was 26.0% and was significantly higher in the dd group and HER2-positive patients. With a median follow-up of 9.51 years median event-free survival (EFS) and overall survival (OS) are 10.85 years and 12.61 years, respectively. Patients achieving pCR had significantly longer EFS and OS. CONCLUSION NAC for BC with AC-paclitaxel can be safely administered in the "real-world' setting with high efficacy. Current efforts are aimed at increasing rates of pCR and identifying patients who may benefit from additional therapy or conversely, de-escalated treatment.
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Affiliation(s)
- Lisi M Dredze
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | - Michael Friger
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Samuel Ariad
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | - Michael Koretz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Division of Surgery and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel
| | - Bertha Delgado
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Pathology, Soroka University Medical Center, Beer Sheva, Israel
| | - Ruthy Shaco-Levy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Pathology, Soroka University Medical Center, Beer Sheva, Israel
| | - Margarita Tokar
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | - Michael Bayme
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Division of Surgery and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel
| | - Ravit Agassi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Division of Surgery and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel
| | - Maia Rosenthal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Imaging and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel
| | - Victor Dyomin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Pathology, Soroka University Medical Center, Beer Sheva, Israel
| | - Olga Belochitski
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | - Shai Libson
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Division of Surgery and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel
| | - Tamar Mizrahi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel
| | - David B Geffen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. .,Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel.
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8
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Koyama Y, Kawai S, Uenaka N, Okazaki M, Asaoka M, Teraoka S, Ueda AI, Miyahara K, Kawate T, Kaise H, Yamada K, Ishikawa T. Absolute Lymphocyte Count, Platelet-to-Lymphocyte Ratio, and Overall Survival in Eribulin-treated HER2-negative Metastatic Breast Cancer Patients. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:435-441. [PMID: 35403160 PMCID: PMC8962857 DOI: 10.21873/cdp.10058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM To investigate the utility of peripheral blood biomarkers - absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) - for predicting outcomes in eribulin-treated patients with metastatic human epidermal growth factor receptor type 2 (HER2)-negative breast cancer. PATIENTS AND METHODS ALC, NLR, and PLR were retrospectively obtained from pre-treatment blood sampling results of 120 patients and stratified according to means. Univariate and multivariate analyses were performed to investigate the association of clinicopathological factors, including these values, with overall survival (OS) and progression-free survival (PFS). RESULTS The ALC, NLR, and PLR cut-off points were 1,285/μl, 3.3, and 235, respectively. No biomarkers were associated with PFS. However, univariate analysis showed ALC (p=0.044) and PLR (p=0.044) to be significantly associated with OS. CONCLUSION ALC and PLR can predict eribulin efficacy in terms of OS, reflecting the antitumour immune response in the microenvironment and indicating eribulin's effectiveness.
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Affiliation(s)
- Yoichi Koyama
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Saori Kawai
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Natsuki Uenaka
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Miki Okazaki
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Mariko Asaoka
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Saeko Teraoka
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - A I Ueda
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kana Miyahara
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takahiko Kawate
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Kaise
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kimito Yamada
- Department of Breast Oncology and Surgery, Tokyo Medical University Hachioji Medical Centre, Tokyo, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University, Tokyo, Japan
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9
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Zhou Q, Dong J, Sun Q, Lu N, Pan Y, Han X. Role of neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with breast cancer receiving neoadjuvant chemotherapy: a meta-analysis. BMJ Open 2021; 11:e047957. [PMID: 34561257 PMCID: PMC8475153 DOI: 10.1136/bmjopen-2020-047957] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/06/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) is recognised as a suitable prognostic biomarker in patients with breast cancer. Nevertheless, the efficacy of this biomarker in predicting the pathological complete response (pCR) and survival in patients with breast cancer receiving neoadjuvant chemotherapy (NACT) is still controversial. This meta-analysis aimed to identify the association between baseline NLR and the prognosis of patients with breast cancer treated with NACT. DESIGN Meta-analysis. DATA SOURCES Relevant literature published before 1 May 2021 was searched using the Cochrane Library, Embase, PubMed and the Web of Science databases. ELIGIBILITY CRITERIA All studies involving patients with breast cancer treated with NACT and peripheral blood pretreatment NLR recorded as a dichotomous variable were included. DATA EXTRACTION AND SYNTHESIS Two researchers independently extracted and evaluated OR/HR and its 95% CIs of survival outcomes and clinicopathological parameters. RESULTS A total of 19 studies were identified. From each study, the impact of NLR on the pCR, OR and HR, with their 95% CIs were extracted and combined using either a random or fixed-effects model. The results indicate that a higher pCR in patients with a low NLR (OR 1.620, 95% CI 1.209 to 2.169, p<0.001). In addition, an elevated NLR predicted lower disease-free survival (HR 2.269, 95% CI 1.557 to 3.307, p<0.001) and overall survival (HR 1.691, 95% CI 1.365 to 2.096, p<0.001) in patients with breast cancer treated with NACT. CONCLUSIONS NLR is a suitable biomarker for predicting pCR and survival in patients with breast cancer receiving NACT.
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Affiliation(s)
- Qiong Zhou
- Department of Oncology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jie Dong
- Department of Oncology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Qingqing Sun
- Department of Oncology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Nannan Lu
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Yueyin Pan
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Xinghua Han
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Hefei, Anhui, China
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10
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Prognostic Relevance of Neutrophil to Lymphocyte Ratio (NLR) in Luminal Breast Cancer: A Retrospective Analysis in the Neoadjuvant Setting. Cells 2021; 10:cells10071685. [PMID: 34359855 PMCID: PMC8303552 DOI: 10.3390/cells10071685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
The neutrophil to lymphocyte ratio (NLR) is a promising predictive and prognostic factor in breast cancer. We investigated its ability to predict disease-free survival (DFS) and overall survival (OS) in patients with luminal A- or luminal B-HER2-negative breast cancer who received neoadjuvant chemotherapy (NACT). Pre-treatment complete blood cell counts from 168 consecutive patients with luminal breast cancer were evaluated to assess NLR. The study population was stratified into NLRlow or NLRhigh according to a cut-off value established by receiving operator curve (ROC) analysis. Data on additional pre- and post-treatment clinical-pathological characteristics were also collected. Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models were used for statistical analyses. Patients with pre-treatment NLRlow showed a significantly shorter DFS (HR: 6.97, 95% CI: 1.65–10.55, p = 0.002) and OS (HR: 7.79, 95% CI: 1.25–15.07, p = 0.021) compared to those with NLRhigh. Non-ductal histology, luminal B subtype, and post-treatment Ki67 ≥ 14% were also associated with worse DFS (p = 0.016, p = 0.002, and p = 0.001, respectively). In a multivariate analysis, luminal B subtype, post-treatment Ki67 ≥ 14%, and NLRlow remained independent prognostic factors for DFS, while only post-treatment Ki67 ≥ 14% and NLRlow affected OS. The present study provides evidence that pre-treatment NLRlow helps identify women at higher risk of recurrence and death among patients affected by luminal breast cancer treated with NACT.
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11
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Boér K, Kahán Z, Landherr L, Csőszi T, Máhr K, Ruzsa Á, Horváth Z, Budai B, Rubovszky G. Pathologic Complete Response Rates After Neoadjuvant Pertuzumab and Trastuzumab with Chemotherapy in Early Stage HER2-Positive Breast Cancer - Increasing Rates of Breast Conserving Surgery: A Real-World Experience. Pathol Oncol Res 2021; 27:1609785. [PMID: 34257621 PMCID: PMC8262177 DOI: 10.3389/pore.2021.1609785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022]
Abstract
Purpose: The neoadjuvant use of pertuzumab and trastuzumab with chemotherapy improves the pathologic complete response (pCR) in early HER2+ breast cancer. The aim of this study was to determine the pCR rate obtained with dual HER2 blockade in routine clinical practice. The secondary and tertiary objective was to investigate the impact of neoadjuvant systemic therapy (NST) on performing breast-conserving surgery and survival data. Methods: This was a multicentre, retrospective, observational study in patients with stage II and III HER2+ early breast cancer who received pertuzumab and trastuzumab-based NST. Data were collected from patients’ medical records. Results: Eighty-two patients were included in the study treated in 8 cancer centers in Hungary between March 2015 and January 2020. The study included women with a median age of 50.3 years. The majority of the patients (95%) received a sequence of anthracycline-based chemotherapy followed by docetaxel. pCR was achieved in 54% of the cases. As a result of NST a significant increase of conservative breast surgeries (33% vs. 3.6% planned, p = 0.0001) was observed. Ki67 expression and neutrophil-to-lymphocyte ratio (NLR) significantly predicted pCR. None of the variables were independent predictors of DFS. Conclusion: The pCR rate achieved in our study demonstrates the reproducibility of trial data in a real-world population. The rate of breast-conserving surgery was significantly increased.
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Affiliation(s)
- Katalin Boér
- Department of Medical Oncology, Szent Margit Hospital, Budapest, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - László Landherr
- Department of Oncoradiology, Uzsoki Teaching Hospital, Budapest, Hungary
| | - Tibor Csőszi
- Department of Oncology, Jász-Nagykun-Szolnok Hetényi County Hospital, Szolnok, Hungary
| | - Károly Máhr
- Department of Medical Oncology, Zala County Hospital, Zalaegerszeg, Hungary
| | - Ágnes Ruzsa
- Department of Oncology, Somogy County Kaposi Mór Hospital, Kaposvár, Hungary
| | - Zsolt Horváth
- Oncoradiological Center, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Barna Budai
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Gábor Rubovszky
- Department of Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Thoracic and Abdominal Tumors and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
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12
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Kim M, Park YG, Park YH. C-reactive protein/albumin ratio as an indicator of disease activity in Behçet's disease and human leukocyte antigen-B27-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1985-1992. [PMID: 33929591 DOI: 10.1007/s00417-021-05207-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/13/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To explore the role of systemic inflammatory markers as indicators of acute exacerbation of chronic diseases and disease activity in uveitis. METHODS This study included 50 patients with Behçet's disease (BD)-associated uveitis and 52 patients with human leukocyte antigen-B27 (HLA-B27)-associated uveitis. Laboratory tests were conducted to measure complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) during the uveitis phase and after resolution. The results measured during the two phases were assessed and compared. RESULTS The mean age of the participants was 41.4 ± 10.8 years; 68.6% of the patients were male. In both groups, ESR, CRP, and CAR were significantly higher during the uveitic phase (P < .001). However, the white blood cell count, albumin, NLR, and PLR measured during the uveitic phase and after resolution did not vary significantly (P > .05). ESR and CAR were correlated with the severity of intraocular inflammation. The area under the curve (AUC) of CAR, which was used to predict the presence of uveitis, was 0.801 (95% CI, 0.741-0.861); this value is strong compared with those of other inflammatory biomarkers. CONCLUSIONS CAR is correlated with the severity of intraocular inflammation in BD- and HLA-B27-associated uveitis. Furthermore, CAR appears to be a useful marker of disease activity for uveitis and is the most sensitive marker for discriminating the presence of acute uveitis in patients who have chronic uveitis as a symptom of BD- and HLA-B27-associated diseases.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young-Gun Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea.
- Catholic Institute for Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea.
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13
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Zhu J, Jiao D, Zhao Y, Guo X, Yang Y, Xiao H, Liu Z. Development of a predictive model utilizing the neutrophil to lymphocyte ratio to predict neoadjuvant chemotherapy efficacy in early breast cancer patients. Sci Rep 2021; 11:1350. [PMID: 33446717 PMCID: PMC7809019 DOI: 10.1038/s41598-020-80037-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Neutrophils and lymphocytes are key regulators of breast cancer (BC) development and progression. Neutrophil to lymphocyte ratio (NLR) values have been found to offer clear prognostic utility when evaluating BC patients. In this study, we sought to determine whether BC patient baseline NLR values are correlated with pathological complete response (pCR) following neoadjuvant chemotherapy (NCT) treatment. In total, 346 BC patients underwent NCT at our hospital from January 1, 2014 to October 31, 2019, and data pertaining to these patients were retrospectively analyzed. Correlations between clinicopathological characteristics and pCR rates were assessed via multivariate logistic regression analyses. A predictive scoring model was used to gauge the likelihood of pCR based upon regression coefficient (β) values for each significant variable identified through these analyses. NLR cut-off values suitable for identifying patients likely to achieve pCR following NCT treatment were calculated using receiver operating characteristic (ROC) curves. All patients in the present study were females with a median age of 48 years old (range 22–77). An optimal NLR cut-off value of 1.695 was identified and was associated with respective sensitivity and specificity values of 63.6% and 45.5%. We found that higher NLR values were significantly associated with younger age, premenopausal status, and non-pCR status. Logistic regression analyses indicated that NLR, tumor size, hormone receptor (HR) status, and Ki-67 expression were all independent predictors of pCR. The area under the curve (AUC) for the resultant predictive scoring model was 0.705, and this model was assessed via K-fold cross-validation (k = 10) and bootstrapping validation, yielding respective AUC values of 0.68 and 0.694. Moreover, the incorporation of NLR into this predictive model incrementally improved its overall prognostic value relative to that of a model not incorporating NLR (AUC = 0.674). BC patients with a lower baseline NLR are more likely to exhibit pCR following NCT treatment, indicating that NLR may be a valuable biomarker for BC patient prognostic evaluation and treatment planning. Overall, our results demonstrate that this NLR-based predictive model can efficiently predict NCT efficacy in early BC patients with a high degree of accuracy.
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Affiliation(s)
- Jiujun Zhu
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China.
| | - Dechuang Jiao
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China
| | - Yajie Zhao
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China
| | - Xuhui Guo
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China
| | - Yue Yang
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China
| | - Hui Xiao
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China
| | - Zhenzhen Liu
- Department of Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127, Dongming Road, Zhengzhou, China.
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14
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Van Berckelaer C, Van Geyt M, Linders S, Rypens C, Trinh XB, Tjalma WAA, Van Laere S, Colpaert C, Dirix L, van Dam PA. A high neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are associated with a worse outcome in inflammatory breast cancer. Breast 2020; 53:212-220. [PMID: 32890963 PMCID: PMC7481565 DOI: 10.1016/j.breast.2020.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Inflammatory breast cancer (IBC) is an uncommon, but aggressive form of breast cancer that accounts for a disproportionally high fraction of breast cancer related mortality. The aim of this study was to explore the peripheral immune response and the prognostic value of blood-based biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), in a large IBC cohort. Patients & methods We retrospectively identified 127 IBC patients and collected lab results from in-hospital medical records. The differential count of leukocytes was determined at the moment of diagnosis, before any therapeutic intervention. A cohort of early stage (n = 108), locally advanced (n = 74) and metastatic breast cancer patients (n = 41) served as a control population. Results The NLR was significantly higher in IBC compared to an early stage breast cancer cohort, but no difference between IBC patients and locally advanced breast cancer patients was noted. In the metastatic setting, there was also no significant difference between IBC and nIBC. However, a high NLR (>4.0) remained a significant predictor of worse outcome in IBC patients (HR: 0.49; 95% CI: 0.24–1.00; P = .05) and a lower platelet-lymphocyte ratio (PLR) (≤210) correlated with a better disease-free survival (DFS) (HR: 0.51; 95% CI: 0.28–0.93; P = .03). Conclusion Patients with a high NLR (>4.0) have a worse overall prognosis in IBC, while the PLR correlated with relapse free survival (RFS). Since NLR and PLR were not specifically associated with IBC disease, they can be seen as markers of more extensive disease. There is no association between NLR or PLR and inflammatory breast cancer (IBC). IBC and non-inflammatory breast cancer elicit a similar peripheral immune response. A high neutrophil-to-lymphocyte ratio (NLR) is associated with a worse overall survival in IBC. A high platelet-lymphocyte ratio (PLR) correlates with a worse disease-free survival in IBC. An elevated PLR or NLR should be seen as a marker of more extensive disease in IBC.
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Affiliation(s)
- C Van Berckelaer
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - M Van Geyt
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - S Linders
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - C Rypens
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium
| | - X B Trinh
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - S Van Laere
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium
| | - C Colpaert
- Department of Pathology, UZA, Antwerp University Hospital, Edegem, Belgium
| | - L Dirix
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium; Department of Oncology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
| | - P A van Dam
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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15
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Prognostic value of neutrophil-to-lymphocyte ratio in human epidermal growth factor receptor 2-negative breast cancer patients who received neoadjuvant chemotherapy. Sci Rep 2020; 10:13078. [PMID: 32753659 PMCID: PMC7403312 DOI: 10.1038/s41598-020-69965-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
We aimed to investigate the correlation between neutrophil-to-lymphocyte ratio (NLR) and pathologic complete response (pCR) and survival outcomes in human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients who received neoadjuvant chemotherapy. The baseline NLR was evaluated in non-metastatic, HER2-negative breast cancer patients who received neoadjuvant chemotherapy. Baseline NLR was calculated as absolute neutrophil per lymphocyte count from pre-treatment blood samples. Any value ≥ 2.74 was considered to be a high NLR. In the 1,097 patients studied, 272 (24.4%) had high NLR and 825 (75.6%) had low NLR. The high NLR was an independent factor for pCR (OR 0.595; 95% CIs 0.398–0.890; P = 0.011). Furthermore, high NLR was a significant independent parameter affecting DFS (HR 2.298; 95% CIs 1.691–3.124; P < 0.001) and OS (HR 1.905; 95% CIs 1.167–3.108; P = 0.010). Regardless of the baseline NLR, survival outcomes were excellent in patients who achieved pCR, but high NLR was associated with worse survival for patients with residual invasive disease. Our study showed that NLR was predictive for treatment response and a prognostic factor in patients with HER2-negative breast cancer who received neoadjuvant chemotherapy. Moreover, we identified that high NLR was associated with poor survival outcomes in patients who did not achieve pCR.
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