To investigate the effect of neutrophil-to-lymphocyte ratio (NLR) and fibrinogen-to-albumin ratio (FAR) of preoperative peripheral blood on the prognosis of breast cancer patients.

A total of 995 breast cancer patients admitted to Chengde Medical College from January 1, 2013 to December 31, 2015 were enrolled in a retrospective study. They were divided into recurrence group (n=121) and non-recurrence group (n=874). The clinicopathological characteristics and preoperative parameters in peripheral blood test were compared between two groups to evaluate the effect of preoperative NLR and FAR on the prognosis of patients. The patients’ age and preoperative parameters in peripheral blood test were quantitative data of the skew distribution, so they were expressed as M (P₂₅-P₇₅) and compared between two groups using the rank sum test. The other clinicopathological characteristics were compared between two groups using χ² test. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of NLR and FAR and determine the optimal cut-off value. The Kaplan-Meier method was used to draw the recurrence-free survival curves of patients with high and low NLR/FAR, and the log-rank method was used for comparison. The Cox proportional hazards stepwise regression model was used to analyze the factors affecting the prognosis of patients.

The cut-off value of FAR was 0.079, area under the ROC curve (AUC) 0.778, 95%CI 0.733-0.823, sensitivity 66.9%(81/121), specificity 78.1%(683/874), positive predictive value 0.298, negative predictive value 0.945, positive likelihood ratio 3.597 and negative likelihood ratio 0.407. The cut-off value of NLR was 2.042, AUC 0.863, 95%CI 0.733-0.823, sensitivity 79.3%(96/121), specificity 80.3%(702/874), positive predictive value 0.346, negative predictive value 0.959, positive likelihood ratio 4.241 and negative likelihood ratio 0.225. The recurrence-free survival showed a significant difference between patients with NLR≥2.042 and NLR<2.042, between patients with FAR≥0.079 and FAR<0.079 (χ²=19.512, P<0.001; χ²=28.125, P<0.001). The results of univariate analysis showed that body mass index, primary tumor diameter, axillary lymph node metastasis, HER-2 expression, vascular invasion, histological grade, preoperative levels of neutrophils, lymphocytes, fibrinogen and albumin and preoperative NLR and FAR all presented a significant difference (χ²=15.255, 32.096, 134.504, 8.596, 14.065, 8.970, Z=-14.600, -2.760, -3.055, -11.668, -12.942, -9.927, all P<0.050). The results of multivariate analysis showed that primary tumor diameter> 2 cm, axillary lymph node metastasis, vascular invasion, histological grade 2 to 3, HER-2 positive, FAR≥0.079 and NLR≥2.042 are all independent risk factors affecting the prognosis of breast cancer patients (HR=2.347, 95%CI: 1.449-3.801, P=0.001; HR=4.667, 95%CI: 3.061-7.112, P<0.001; HR=1.994, 95%CI: 1.354-2.955, P=0.001; HR=1.676, 95%CI: 1.139-2.467, P=0.009; HR=1.586, 95%CI: 1.090-2.307, P=0.016; HR=2.214, 95%CI: 1.459-3.359, P<0.001; HR=6.491, 95%CI: 4.167-10.113, P<0.001).

Preoperative NLR and FAR can be used as a marker to predict the diagnosis of breast cancer prognosis.