The Preoperative Neutrophil/Lymphocyte Ratio Does not Correlate with the 21-Gene Recurrence Score in Estrogen Receptor-Positive Breast Cancer Patients

Grenader, Tal; Plotkin, Yevgeni; Geffen, David

doi:10.1159/000370341

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…One of the studies also showed that elevated NLR was associated with worse disease-specific survival particularly among patients with the luminal A subtype breast cancer ( 13 ). On the other hand, a pretreatment NLR ≥2.5 was not associated with the 21-gene recurrence score in a population of 242 ER+ breast cancer patients ( 38 ). A significant association of pretreatment NLR with both overall and disease-free survival has been reported in studies based on triple-negative breast cancer patients ( 19 , 39 ).…”

Section: Discussionmentioning

confidence: 96%

The Pretreatment Neutrophil/Lymphocyte Ratio Is Associated with All-Cause Mortality in Black and White Patients with Non-metastatic Breast Cancer

et al. 2016

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The pretreatment neutrophil/lymphocyte ratio (NLR), derived from differential white blood cell counts, has been previously associated with poor prognosis in breast cancer. Little data exist, however, concerning this association in Black patients, who are known to have lower neutrophil counts than other racial groups. We conducted a retrospective cohort study of 236 Black and 225 non-Hispanic White breast cancer patients treated at a single institution. Neutrophil and lymphocyte counts were obtained from electronic medical records. Univariate and multivariate Cox regression models were used to determine hazard ratios (HRs) and 95% confidence intervals (95% CIs) of all-cause mortality and breast cancer-specific mortality in relation to pretreatment NLR. Overall, there were no associations between an elevated pretreatment NLR (NLR ≥3.7) and all-cause or breast cancer-specific mortality. Among patients without metastasis at the time of diagnosis, an elevated pretreatment NLR was independently associated with all-cause mortality, with a multivariable HR of 2.31 (95% CI: 1.10–4.86). Black patients had significantly lower NLR values than White patients, but there was no evidence suggesting racial heterogeneity of the prognostic utility of NLR. Pretreatment NLR was an independent predictor of all-cause mortality but not breast cancer-specific mortality in non-metastatic breast cancer patients.

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Section: Discussionmentioning

confidence: 96%

The Pretreatment Neutrophil/Lymphocyte Ratio Is Associated with All-Cause Mortality in Black and White Patients with Non-metastatic Breast Cancer

et al. 2016

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“… 26 NLR has not been included with these factors, and the relationship between NLR and RS has not been established yet; however, NLR has been identified as an independent prognostic factor for disease-free survival (DFS) and overall survival (OS) in a variety of solid tumors, 27–30 including BC. 25 , 31–34 A study reported no correlation between ODX RS and NLR, 35 although current theories support the hypothesis that such a correlation might exist. Immunological biomarkers are of high prognostic value when used in addition to other clinicopathological factors.…”

Section: Introductionmentioning

confidence: 82%

“…However, Grenader et al found no association between the preoperative NLR as a predictor of ODX RS. 35 A possible explanation for the differences could be attributed to the following factors: i) the NLR cutoff value of 2.5, which was obtained from a heterogeneous group of Asians with all BC subtypes (28.9% HER2-positive and 22.3% triple-negative), with node positivity (35%) 33 and ii) the exclusion criteria for factors affecting the NLR were not specified in the previous study. 35 These factors might have influenced the negative outcome as the median NLR/optimal cutoff varies by disease characteristics, ethnicity, 53 , 54 and systemic factors that are known to alter white blood cell counts.…”

Section: Discussionmentioning

confidence: 98%

“… 35 A possible explanation for the differences could be attributed to the following factors: i) the NLR cutoff value of 2.5, which was obtained from a heterogeneous group of Asians with all BC subtypes (28.9% HER2-positive and 22.3% triple-negative), with node positivity (35%) 33 and ii) the exclusion criteria for factors affecting the NLR were not specified in the previous study. 35 These factors might have influenced the negative outcome as the median NLR/optimal cutoff varies by disease characteristics, ethnicity, 53 , 54 and systemic factors that are known to alter white blood cell counts. We obtained optimal cutoff values from the ROC curve and followed prespecified exclusion criteria, such as active infection, autoimmune diseases, and medications such as steroids ( Figure 1 ).…”

Section: Discussionmentioning

confidence: 98%

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Association Between Neutrophil-Lymphocyte Ratio and Oncotype Dx Recurrence Score in Early-Stage Hormonal Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer

Alshamsan¹,

Alshibany²,

Elshenawy³

et al. 2021

CMAR

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Purpose The correlation between the preoperative neutrophil-to-lymphocyte ratio (NLR) and Oncotype DX ® (ODX) recurrence score (RS) has not yet been established. We aimed to investigate the association between NLR and ODX RS in patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2−) early-stage breast cancer (BC). Patients and Methods This retrospective study included consecutive patients with HR+/HER2−, node-negative primary BC who underwent surgical tumor resection from 2011 to 2019. Receiver operating characteristic curve analysis was used to obtain an optimal NLR cutoff value. Logistic regression analyses were used to estimate associations between various parameters and ODX RS. Furthermore, the factors significantly associated with the ODX RS in multivariable analysis were incorporated in a separate model and estimated using logistic regression. Results A total of 160 patients were enrolled. The optimal preoperative NLR cutoff was 2.15. Multivariable analysis revealed that NLR and tumor grade (G1/G2 vs G3) were independent predictive factors of high RS cutoff (≥26). Moreover, including the two variables yielded a stronger association; patients with low NLR and low-grade tumors were unlikely to have high RS (≥26; odds ratio [OR] = 0.03, 95% confidence interval [CI]: 0.006–0.154; p < 0.001). Conversely, the presence of any of the following factors made patients unlikely to have low RS (<16; OR = 0.34, 95% CI: 0.16–0.73; p = 0.006): high NLR, high grade, or high Ki-67 levels (>20). Conclusion NLR is a promising independent predictor of RS. Furthermore, in addition to tumor grade and Ki-67 level, they together are also a potential indicator of high and low RS. However, further studies are required to validate this hypothesis.

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“…Furthermore, investigating immunocyte ratios as prognostic marker in breast cancer molecular subtypes found that lymphocyte-monocyte ratio (LMR) were prognostic factors of DFS in Luminal A, Luminal B and Her positive tumours. In Triple negative breast cancer (TNBC) tumours the NLR predicted DFS [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Peripheral Blood Cell Ratios as Prognostic Indicators in a Neoadjuvant Chemotherapy-Treated Breast Cancer Cohort

et al. 2022

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Breast cancer represents a heterogeneous condition in which the interaction between host immune response and primary oncogenic events can impact disease progression. Ratios of systemic blood-based immunocytes have emerged as clinically-relevant prognostic biomarkers in cancer patients. The NLR (neutrophil-to-lymphocyte ratio) has been shown to be prognostic in a variety of cancers, including breast cancer. However, evaluation of the prognostic value for overall survival (OS) and disease-free survival (DFS) of other key immunocyte ratios—neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-white cell count ratio (NWR), lymphocyte-to-white cell count ratio (LWR), monocyte-to-white cell count ratio (MWR), platelet-to-lymphocyte (PLR)—by breast cancer subtypes in a neoadjuvant chemotherapy (NAC) cohort remains to be fully explored. An NAC-treated breast cancer cohort, comprised of Luminal A, Luminal B, HER2-positive, and triple negative/basal breast cancers, treated at a tertiary referral center (minimum 3-year follow-up), was used to calculate immunocyte ratios and immunocyte cut-off values, calculated with >80% specificity (using decision tree modeling). The association with subtype-specific OS, DFS, and tumor grade was analyzed using cut offs calculated using both receiver operating characteristic curves and decision tree modelling. Decision tree calculated ratios showed that LMR (5.29) and MWR (0.06) were significantly associated with Luminal A OS (p = 0.004 and p = 0.022) and DFS (p = 0.004 and p = 0.022), and Luminal B OS (p = 0.027 and p = 0.008) and DFS (p = 0.005 and p = 0.007). NLR (1.79) and LWR (0.30) were significantly associated with HER2-positive OS (p = 0.013 and p = 0.043). NLR (1.79) and NWR (0.62) were significantly associated with DFS (p = 0.035 and p = 0.021). No significant association we observed between any immunocyte ratio in the triple negative cohort. Our results demonstrate the subtype-specific prognostic value of immunocyte ratios in NAC-treated breast cancer patients. Further validation of immunocyte ratios will provide clinicians with a new prognostic aid for disease management and monitoring.

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The Preoperative Neutrophil/Lymphocyte Ratio Does not Correlate with the 21-Gene Recurrence Score in Estrogen Receptor-Positive Breast Cancer Patients

Cited by 3 publications

References 19 publications

The Pretreatment Neutrophil/Lymphocyte Ratio Is Associated with All-Cause Mortality in Black and White Patients with Non-metastatic Breast Cancer

The Pretreatment Neutrophil/Lymphocyte Ratio Is Associated with All-Cause Mortality in Black and White Patients with Non-metastatic Breast Cancer

Association Between Neutrophil-Lymphocyte Ratio and Oncotype Dx Recurrence Score in Early-Stage Hormonal Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer

Peripheral Blood Cell Ratios as Prognostic Indicators in a Neoadjuvant Chemotherapy-Treated Breast Cancer Cohort

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