J Breast Cancer.  2019 Sep;22(3):425-438. 10.4048/jbc.2019.22.e41.

The Role of Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio in Predicting Neoadjuvant Chemotherapy Response in Breast Cancer

• Kim HY
• Kim TH
• Yoon HK
• Lee A

• KMID: 2458863
• DOI: http://doi.org/10.4048/jbc.2019.22.e41

Abstract

PURPOSE
The role of the host immunologic environment is crucial in cancer progression. Recent studies revealed that neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), are possible surrogate markers of outcome in various cancers. In breast cancer, the therapeutic effect of neoadjuvant chemotherapy (NAC) differs in patients, and higher response rate reflects better outcomes. This study aimed to determine the predictive value of peripheral blood NLR and PLR for NAC response along with their prognostic role in breast cancer. METHOD: A total of 105 patients with breast cancer treated with NAC between 2009 and 2017 were analyzed retrospectively. NAC response and prognosis (disease-free-survival [DFS], progression-free-survival [PFS] and overall survival [OS]) according to NLR and PLR were evaluated. According to the optimal cut-off values for NAC response obtained from receiver operating characteristic (ROC) curves, patients satisfying both low NLR and PLR levels (low-ratio group) were compared to those who did not (high-ratio group).
RESULTS
The NLR cut-off value was ≤ 2.21 (area under the ROC curve [AUC], 0.617; 95% confidence interval [CI], 0.517-0.710; p=0.030) with 94.1% sensitivity and 38.0% specificity. The PLR cut-off value was ≤ 143.36 (AUC, 0.618; 95% CI, 0.518-0.711; p = 0.040) with 85.3% sensitivity and 39.4% specificity. The low-ratio group demonstrated a better NAC response (p = 0.006) in multivariate analysis than the high-ratio group. The low-ratio group showed better DFS and PFS (p = 0.046 and p = 0.040, respectively) and longer OS (p = 0.078) in univariate survival analysis than the high-ratio group. In multivariate analysis, the low-ratio group had significantly better PFS (p = 0.049) and higher DFS (p = 0.054) than the high-ratio group.
CONCLUSIONS
The combination of NLR and PLR showed improved prediction of NAC response, revealing their potential as screening tools, significant prognostic role in breast cancer patients who receive NAC. Further studies with subgroup analysis, larger population and longer follow up duration are required.

Keyword

Blood cell count; Breast; Carcinoma; Prognosis

MeSH Terms

Biomarkers
Blood Cell Count
Breast Neoplasms*
Breast*
Drug Therapy*
Follow-Up Studies
Humans
Mass Screening
Methods
Multivariate Analysis
Prognosis
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Biomarkers

Figure

• 

  Figure 1 ROC curve analysis for the cut-off value to predict NAC response (A) cut-off value of NLR (B) cut-off value of PLR. NLR cut-off was ≤ 2.21 with 94.1% sensitivity and 38.0% specificity. PLR cut-off was ≤ 143.36 with 85.3% sensitivity and 39.4% specificity. ROC = receiver operating characteristic; NAC = neoadjuvant chemotherapy; NLR = neutrophil-lymphocyte ratio; PLR = platelet-lymphocyte ratio.

• 

  Figure 2 Non-parametric analysis of NLR and PLR with NAC response. (A) NAC response and NLR demonstrated tendency of correlation (p = 0.053, Mann-whitney U). (B) NAC response and PLR demonstrated tendency of correlation (p = 0.051, Mann-whitney U). NLR = neutrophil-lymphocyte ratio; PLR = platelet-lymphocyte ratio; NAC = neoadjuvant chemotherapy.

• 

  Figure 3 Correlation of prognosis and NLR and PLR index in terms of DFS and PFS. (A) DFS and NLR did not demonstrate significant correlation (p = 0.306, Log rank) (B) PFS and NLR did not demonstrate significant correlation (p = 0.281, Log rank) (C) DFS and PLR did not demonstrate significant correlation (p = 0.326, Log rank) (D) PFS and PLR did not demonstrate significant correlation (p = 0.349, Log rank). NLR = neutrophil-lymphocyte ratio; PLR = platelet-lymphocyte ratio; DFS = disease-free-survival; PFS = progression-free-survival.

• 

  Figure 4 Correlation of prognosis and both cut-off satisfaction in terms of DFS, PFS and OS. (A) The Low-index group demonstrated longer DFS (p = 0.046, Log rank). (B) The Low-index group demonstrated longer PFS (p = 0.040, Log rank). (C) The Low-index group demonstrated tendency of longer OS (p = 0.078, Log rank). DFS = disease-free-survival; PFS = progression-free-survival; OS = overall survival.

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