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

Abstract

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.

Prognostic Significance of Neutrophil–to–lymphocyte Ratio in the Framework of the 8th TNM Edition for Breast Cancer

“…This finding is in agreement with the results obtained in a recent study conducted in a cohort of Italian women with early BC, demonstrating an association with T2 and N1 stage, but not with all other prognostic variables (30). Other studies, mostly involving BC patients (17,19,21,22,32,33), although with conflicting results (10,13,20,26,34). To explain these discrepancies, Wei et al advocated the fact that studies from Eastern countries had a positive result with perfect homogeneity, contrarily to that achieved in studies from Western countries, advocating the use of race-related cutoff values in future studies (5).…”

“…Based on the above and being aware of the contradictory results previously reported (13,20,26), the present study was designed to investigate the prognostic value of NLR in a cohort of prospectively enrolled BC patients re-staged according to the prognostic TNM, with the aim to evaluate whether NLR might represent an additional biological criterion able to discriminate patients with worse prognosis within the new BC staging system.…”

Prognostic value of lymphocyte-to-monocyte ratio among Asian lung cancer patients: a systematic review and meta-analysis

“…Inflammation is critical in tumor growth, invasion, and metastasis; many inflammatory indicators, including neutrophilocyte-to-lymphocyte ratio, derived neutrophilcyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and LMR, are prognostic factors in various cancers [ 15 , 19 , 24 – 26 ]. This meta-analysis is the first to determine the prognostic effect of LMR on lung cancer.…”

The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict efficacy of platinum-based chemotherapy in patients with metastatic triple negative breast cancer

“…High NLR has also been associated with an increased risk of death in heterogeneous BC patient populations 21 , including patients with limited-stage TNBC 22 , 23 . However, none of these studies specifically assessed the role of NLR in mTNBC and, even in those studies including different proportions of patients with mBC (4.2–13.9%), subgroup analyses in specific tumor biology subgroups, or based on the type of ChT, were not reported 24 – 28 .…”