Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis

Michele Orditura; Gennaro Galizia; Anna Diana; Ciro Saccone; Luigi Cobellis; Jole Ventriglia; Francesco Iovino; Ciro Romano; Floriana Morgillo; Lavinia Mosca; Maria Rosaria Diadema; Eva Lieto; Eugenio Procaccini; Ferdinando De Vita; Fortunato Ciardiello

doi:10.1136/esmoopen-2016-000038

Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis

ESMO Open. 2016 Mar 7;1(2):e000038. doi: 10.1136/esmoopen-2016-000038. eCollection 2016.

Authors

Affiliations

¹ Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
² Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences , Second University of Naples School of Medicine , Naples , Italy.
³ Division of Breast Surgery, Medicina Futura Group, Naples, Napoli , Italy.
⁴ Division of Gynecology and Obstetrics, Department of Women, Children and Surgery , Second University of Naples School of Medicine , Naples , Italy.
⁵ Division of Internal Medicine, Allergy and Clinical Immunology, Department of Medical and Surgical Sciences , Second University of Naples School of Medicine , Naples , Italy.
⁶ Breast Unit , Second University of Naples School of Medicine , Naples , Italy.

Abstract

Objective: To assess the correlation between presurgery neutrophil to lymphocyte ratio (NLR) and distant metastasis-free survival (DMFS) in patients with early breast cancer.

Design: Retrospective analysis.

Participants: 300 Caucasian patients with early (T1-2, N0-1, non-metastatic) breast cancer who were followed from July 1999 to June 2015 at our Institution.

Main outcome measures: Distant metastasis-free survival (DMFS).

Results: Of whole populations (300 patients), 134 and 166 patients were grouped as low and high NLR, respectively, on the basis of NLR value of 1.97, as established by receiver operating characteristic (ROC) curve analysis (area under curve (AUC)=0.625, p=0.0160). The DMFS rates for 1, 3, 6, 9, 12 and 15 years were better in low NLR patients (100%, 98.9%, 91.7%, 82.7%, 82.7%, 82.7%, respectively), than in high NLR patients (99.4%, 94.3%, 84.5%, 69.2%, 66.0%, 51.4%, respectively), with a statistically significant association. On multivariate analysis, premenopausal status (HR=2.78, 95% CI 1.36 to 5.67, p=0.0049), N1 stage (HR=2.31, 95% CI 1.16 to 4.60, p=0.0167) and a high NLR value (HR=2.64, 95% CI 1.22 to 5.638, p=0.0133) were shown to be independent prognostic factors related to poor recurrence rate. To avoid risk of confounding bias, a propensity score-matched analysis was performed and multivariate analysis according to the Cox model confirmed premenopausal status (HR=2.94, 95% CI 1.25 to 6.93, p=0.0136), N1 stage (HR=2.77, 95% CI 1.25 to 6.12, p=0.0117) and high NLR values (HR=2.52, 95% CI 1.11 to 5.73, p=0.0271), as independent prognostic variables of worse outcome.

Conclusions: This is the first study, to our knowledge, to show a significant correlation between high NLR and worse prognosis in Caucasian patients with early breast cancer by means of propensity score-matched analysis. Further well designed prospective trials with a large sample size are needed to verify our findings and to justify introducing NLR assessment in clinical practice for prediction of cancer recurrence.

Keywords: early breast cancer; neutrophil to lymphocyte ratio; prognosis.