Prognostic Significance Of The Ratio Of Neutrophil To Lymphocyte In Breast Cancer

Objective: Breast cancer is currently the most common cancer among women, which threats the woman’s life directly.In our country,breast cancer is one of the primary malignant tumors.The incidence of breast cancer tops the list in urban female malignant tumors,and the incidence of breast cancer increases annually in China.In the latest statistical analysis of malignant tumors’ morbidity and mortality in Hebei province,it reported that the leading place of female malignant tumors was breast cancer.Although it can shrink the tumor and reduce the clinical stage by neoadjuvant chemotherapy,even extend the patients overall survival.There is a lack of clear standards for prognosis.For many solid tumor,systemic inflammatory response were reported to be independent prognostic factors for survial.Inflammation is closely related with the occurrence,metastasis and prognosis in various cancers.The inflammation indexes included neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),C-reactive protein(CRP),etc.NLR has demonstrated the link between the inflammatory system and prognosis in different types of cancer.We performed this study of breast cancer patients to evaluate the prognostic value of the NLR as well as other clinical factors.Methods: A retrospective analysis from January 2009 to January 2011,there are 263 cases of breast cancer patients treated in the first Hospital of Qinhuangdao after pathology diagnosis.All the patients were women,aged 25-78 years old.We analysed the laboratory results before treatment,age,menopausal status,history of tumor,pathology,primary tumor,node stage,metastasis,clinical stage,estrogen receptor status,progesterone receptor status,human epidermal growth factor receptor-2 status, molecular subtype, treatment.According to the ROC curve, while taking into account the sensitivity and specificity,we selected NLR=2.08 as the cut-off value,and divided the patients into low NLR group(NLR<2.08)and high NLR group(NLR>2.08).Statistical analysis was performed with the statistical package for the social sciences(SPSS) software package version 19.0.We explore the relationship between NLR and clinical factors on prognosis by calculating 5-year survival rate.Results: 1.In term of age, history of cancer, menopausal status, pathology, primary tumor,node stage,metastasis, estrogen receptor status and progesterone receptor status and human epidermal growth factor receptor-2 status, molecular subtype, treatment, there was no statistically significant difference.NLR difference between lower and upper groups has statistics significance(P<0.05) in clinical stage and leukocyte counts before treatment.2.In this study,263 cases of breast cancer 5-year survival rate was 80.23%,which NLR>2.08 group 65.00%,NLR<2.08 group 89.57%.The difference was statistically significant(P<0.01).3.The high and low NLR group has no statistics significance in Luminal B subtype and Her-2 subtype,while it has statistics significance(P<0.05)in Luminal A subtype and triple-negative subtype.4.In univariable analysis, NLR,primary tumor,node stage,clinical stage,molecular subtype and estrogen receptor status had effects on the survival of patients with breast cancer(P<0.05).In multivariable analysis, NLR,clinical stage and molecular subtype were identified as being independent prognostic factors for survival(P<0.05).Conclusion:1.Prognosis in patients with NLR>2.08 is worse than patients with NLR<2.08. The higher the NLR is, the poorer the prognosis.2.NLR,clinical stage and molecular subtype are independent factors in the prognosis of breast cancer.