Prognostic value of peripheral blood neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in breast cancer patients receiving neoadjuvant chemotherapy

doi:10.3877/cma.j.issn.1674-0807.2018.02.006

Abstract

Abstract:

Objective

To evaluate the relationship of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with disease-free survival (DFS) in breast cancer patients who received neoadjuvant chemotherapy (NAC).

Methods

We retrospectively analyzed the clinical data of 283 breast cancer patients with NAC in the First Affiliated Hospital of Chongqing Medical University from January 2013 to March 2015. Cutoff values of NLR and PLR were estimated by Yoden index, and the patients were divided into high or low ratio group according to cutoff values. The correlation of DFS with peripheral blood NLR and PLR was analyzed by Log-rank test and Cox's proportional hazard regression model.

Results

The values of NLR and PLR corresponding to the maximum Yoden index were 1.8 and 130.0 respectively, regarded as cutoff values. Accordingly, there were 180 patients in high NLR group (≥1.8) and 103 patients in low NLR group (<1.8); there were 130 patients in high PLR group (≥130.0) and 153 patients in low PLR group (<130.0). With a median follow-up of 30 months (range: 5 to 46 months), the median DFS in high NLR group was significantly shorter than that in low NLR group (27.0 months vs 34.0 months, Log-rank test: χ²=26.25, P<0.001). The median DFS in high PLR group was significantly shorter than that in low PLR group (27.5 months vs 32.0 months, Log-rank test: χ²=28.32, P<0.001). Totally 239 patients had not achieved pCR after NAC. Among them, high NLR group (n=161) had a significantly worse DFS than low NLR group (n=78) (HR=2.84, 95%CI=1.43-4.45, P=0.002); the high PLR group (n=118) had a significantly worse DFS than low PLR group (n=121) (HR=2.62, 95%CI=1.51-4.61, P=0.001). Cox's proportional hazard regression analysis showed that childbirth history (HR=3.90, 95%CI=1.282-11.874, P=0.016) and high PLR (HR=1.010, 95%CI=1.003-1.017, P=0.004) were significantly associated with DFS in breast cancer patients with NAC, but high NLR was not an independent prognostic factor.

Conclusion

High PLR and NLR in peripheral blood of breast cancer patients before treatment predict a poor prognosis after NAC, and PLR is an independent risk factor.

Key words: Breast neoplasms, Prognosis, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Neoadjuvant chemotherapy

Maoshan Chen, Yanli Zhang, Lingmi Hou, Guanglun Yang, Yunhui Huang, Ping Deng, Hongwei Yang. Prognostic value of peripheral blood neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in breast cancer patients receiving neoadjuvant chemotherapy[J]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(02): 93-99.

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References 29

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变量	变量类型	变量分类及赋值
年龄	X	≤35岁＝0，>35岁＝1
BMI	X	<30 kg/m²＝0，≥30 kg/m²＝1
初潮年龄	X	≤13岁＝0，>13岁＝1
月经状态	X	绝经前＝0，绝经后＝1
生育史	X	未生育＝0，生育＝1
中性粒细胞计数	X	<6×10⁹/L＝0，≥6×10⁹/L＝1
淋巴细胞计数	X	<3×10⁹/L＝0，≥3×10⁹/L＝1
血小板计数	X	<300×10⁹/L＝0，≥300×10⁹/L＝1
PLR	X	PLR<130.0＝0，PLR≥130.0＝1
NLR	X	NLR<1.8＝0，NLR≥1.8＝1
临床分期	X	Ⅱ期＝0，Ⅲ期＝1
pCR	X	non-pCR＝0，pCR＝1
ER	X	阴性＝0，阳性＝1
PR	X	阴性＝0，阳性＝1
HER-2	X	阴性＝0，阳性＝1
是否TNBC	X	非TNBC＝0，TNBC＝1
DFS	Y	疾病未进展＝0，疾病进展＝1

变量	变量类型	变量分类及赋值
年龄	X	≤35岁＝0，>35岁＝1
BMI	X	<30 kg/m²＝0，≥30 kg/m²＝1
初潮年龄	X	≤13岁＝0，>13岁＝1
月经状态	X	绝经前＝0，绝经后＝1
生育史	X	未生育＝0，生育＝1
中性粒细胞计数	X	<6×10⁹/L＝0，≥6×10⁹/L＝1
淋巴细胞计数	X	<3×10⁹/L＝0，≥3×10⁹/L＝1
血小板计数	X	<300×10⁹/L＝0，≥300×10⁹/L＝1
PLR	X	PLR<130.0＝0，PLR≥130.0＝1
NLR	X	NLR<1.8＝0，NLR≥1.8＝1
临床分期	X	Ⅱ期＝0，Ⅲ期＝1
pCR	X	non-pCR＝0，pCR＝1
ER	X	阴性＝0，阳性＝1
PR	X	阴性＝0，阳性＝1
HER-2	X	阴性＝0，阳性＝1
是否TNBC	X	非TNBC＝0，TNBC＝1
DFS	Y	疾病未进展＝0，疾病进展＝1

临床病理因素		例数	构成比(%)
月经状态		?	?
?	绝经前	168	59.4
?	绝经后	115	40.6
临床分期		?	?
?	Ⅱ期	198	70.0
?	Ⅲ期	85	30.0
病理类型		?	?
?	非特殊类型	251	88.7
?	特殊类型	32	11.3
ER状态		?	?
?	阳性	180	63.6
?	阴性	103	36.4
PR状态			?
?	阳性	133	47.0
?	阴性	150	53.0
HER-2状态		?	?
?	阳性	50	17.7
?	阴性	168	59.3
?	未知	65	23.0
分子分型		?	?
?	三阴型	45	15.9
?	非三阴型	214	75.6
?	未知	24	8.5
NAC化疗周期		?	?
?	3	69	24.4
?	4	152	53.7
?	5	56	19.8
?	6	6	2.1
手术方式		?	?
?	改良根治术	281	99.3
?	保留乳房手术	2	0.7
病理疗效评估		?	?
?	pCR	44	15.5
?	non-pCR	239	84.5

临床病理因素		例数	构成比(%)
月经状态		?	?
?	绝经前	168	59.4
?	绝经后	115	40.6
临床分期		?	?
?	Ⅱ期	198	70.0
?	Ⅲ期	85	30.0
病理类型		?	?
?	非特殊类型	251	88.7
?	特殊类型	32	11.3
ER状态		?	?
?	阳性	180	63.6
?	阴性	103	36.4
PR状态			?
?	阳性	133	47.0
?	阴性	150	53.0
HER-2状态		?	?
?	阳性	50	17.7
?	阴性	168	59.3
?	未知	65	23.0
分子分型		?	?
?	三阴型	45	15.9
?	非三阴型	214	75.6
?	未知	24	8.5
NAC化疗周期		?	?
?	3	69	24.4
?	4	152	53.7
?	5	56	19.8
?	6	6	2.1
手术方式		?	?
?	改良根治术	281	99.3
?	保留乳房手术	2	0.7
病理疗效评估		?	?
?	pCR	44	15.5
?	non-pCR	239	84.5

截断值		高比值组	低比值组	HR值	95%CI	χ²值	P值
NLR		?	?	?	?	?	?
?	1.8	≥1.8(n＝161)	<1.8(n＝78)	2.84	1.43～4.45	19.74	0.002
?	2.0	≥2.0(n＝133)	<2.0(n＝106)	2.16	1.28～3.99	13.92	0.006
?	2.5	≥2.5(n＝74)	<2.5(n＝165)	2.16	1.33～4.78	16.57	0.005
?	3.0	≥3.0(n＝36)	<3.0(n＝203)	1.99	1.02～5.93	11.82	0.048
PLR		?	?	?	?	?	?
?	100.0	≥100.0(n＝188)	<100.0(n＝51)	6.30	1.72～5.85	30.21	<0.001
?	130.0	≥130.0(n＝118)	<130.0(n＝121)	2.62	1.51～4.61	21.69	0.001
?	170.0	≥170.0(n＝53)	<170.0(n＝186)	1.84	1.04～4.27	14.95	0.042
?	200.0	≥200.0(n＝21)	<200.0(n＝218)	2.84	1.74～17.10	18.38	0.004

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