Time-Sequencing of the Neutrophil-to-Lymphocyte Ratio to Predict Prognosis of Triple-Negative Breast Cancer

Abstract

Simple Summary Although the outcomes of breast cancer have improved, triple-negative breast cancer (TNBC) still has a poor prognosis. Since the prognosis of TNBC varies, identifying subgroups with particularly poor prognosis is important. The neutrophil-to-lymphocyte ratio (NLR), a systemic biomarker, is a prognostic factor for breast cancer. Since some studies report negative results on the effect of NLR and most analyze only the preoperative baseline NLR, it is difficult to apply the results in actual clinical treatment. Our study showed that the change in the NLR from before surgery to 1 year after surgery gradually increased in the disease progression group and decreased in the no evidence of disease group. Therefore, in addition to standard treatment, immunotherapy, additional chemotherapy, or clinical trials should be considered for TNBC patients who show an increased NLR during adjuvant treatment. Since triple-negative breast cancers (TNBCs) have varying prognoses, it is important to identify subgroups with particularly poor prognosis. The aim of this study was to assess whether changes in the neutrophil-to-lymphocyte ratio (NLR) during the treatment process were associated with poor prognosis in TNBC patients. This study included 600 TNBC patients who underwent surgery from January 2005 to December 2016. The associations of the NLR and clinicopathologic factors with breast cancer recurrence and survival in patients who underwent both definitive local treatment (total mastectomy or breast-conserving surgery with radiotherapy) and systemic chemotherapy were analyzed. The NLRs at four time points (before surgery, before chemotherapy, before radiotherapy, and 1 year after surgery) were assessed. The univariate analysis showed that changes in the NLR before the start of radiotherapy (odds ratio: 1.115, confidence interval: 1.011-1.229) and 1 year after surgery (odds ratio: 1.196, confidence interval: 1.057-1.354) significantly increased the risk of recurrence or death. In multivariate analysis, T stage, N stage, and changes in the NLR were significant factors. A time-sequenced NLR may reflect the prognosis of TNBC patients. A poor prognosis is expected in patients whose NLR increases during treatment compared to the preoperative NLR, and additional treatment is needed.