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ESMO Open
2016 Mar 07;12:e000038. doi: 10.1136/esmoopen-2016-000038.
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Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis.
Orditura M
,
Galizia G
,
Diana A
,
Saccone C
,
Cobellis L
,
Ventriglia J
,
Iovino F
,
Romano C
,
Morgillo F
,
Mosca L
,
Diadema MR
,
Lieto E
,
Procaccini E
,
De Vita F
,
Ciardiello F
.
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OBJECTIVE: To assess the correlation between presurgery neutrophil to lymphocyte ratio (NLR) and distant metastasis-free survival (DMFS) in patients with early breast cancer.
DESIGN: Retrospective analysis.
PARTICIPANTS: 300 Caucasian patients with early (T1-2, N0-1, non-metastatic) breast cancer who were followed from July 1999 to June 2015 at our Institution.
MAIN OUTCOME MEASURES: Distant metastasis-free survival (DMFS).
RESULTS: Of whole populations (300 patients), 134 and 166 patients were grouped as low and high NLR, respectively, on the basis of NLR value of 1.97, as established by receiver operating characteristic (ROC) curve analysis (area under curve (AUC)=0.625, p=0.0160). The DMFS rates for 1, 3, 6, 9, 12 and 15 years were better in low NLR patients (100%, 98.9%, 91.7%, 82.7%, 82.7%, 82.7%, respectively), than in high NLR patients (99.4%, 94.3%, 84.5%, 69.2%, 66.0%, 51.4%, respectively), with a statistically significant association. On multivariate analysis, premenopausal status (HR=2.78, 95% CI 1.36 to 5.67, p=0.0049), N1 stage (HR=2.31, 95% CI 1.16 to 4.60, p=0.0167) and a high NLR value (HR=2.64, 95% CI 1.22 to 5.638, p=0.0133) were shown to be independent prognostic factors related to poor recurrence rate. To avoid risk of confounding bias, a propensity score-matched analysis was performed and multivariate analysis according to the Cox model confirmed premenopausal status (HR=2.94, 95% CI 1.25 to 6.93, p=0.0136), N1 stage (HR=2.77, 95% CI 1.25 to 6.12, p=0.0117) and high NLR values (HR=2.52, 95% CI 1.11 to 5.73, p=0.0271), as independent prognostic variables of worse outcome.
CONCLUSIONS: This is the first study, to our knowledge, to show a significant correlation between high NLR and worse prognosis in Caucasian patients with early breast cancer by means of propensity score-matched analysis. Further well designed prospective trials with a large sample size are needed to verify our findings and to justify introducing NLR assessment in clinical practice for prediction of cancer recurrence.
Figure 1. ROC analysis based on NLR for DMFS. In this model, sensitivity was 75.7% and specificity was 47.9%; AUC was 0.625 (95% CI 0.56 to 0.6), p=0.0160. AUC, area under curve; DMFS, distant metastasis-free survival; NLR, neutrophil to lymphocyte ratio; ROC, receiver operating characteristics.
Figure 2. DMFS of 300 early patients with breast cancer based on NLR value. DMFS, distant metastasis-free survival; NLR, neutrophil to lymphocyte ratio.
Figure 3. Forest plot showing adjusted HRs (oblongs) and 95% CIs (bars) for distant metastasis-free survival rate in 300 early patients with breast cancer undergoing potentially curative surgery, according to subgroup effects. Univariate HRs, as well as HRs adjusted for baseline covariates and related p values, are listed on the right side. Subgroups were defined by factors showing significant correlation with NLR and recurrence rate. NLR, neutrophil to lymphocyte ratio.
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