Postoperative Neutrophil-Lymphocyte Ratio Change On The Prognosis Of Breast Cancer Patients

Objective:Increasing clinical observations and laboratory studies have shown that cancer-related inflammation plays an important role in tumorigenesis,invasion and metastasis.The diversity and complexity of the immune inflammatory response limited its application in cancer treatment.Fortunately,evidences strongly indicate that neutrophil-to-lymphocyte ratio(NLR)correlates with prognosis of patient suffering from malignant tumors including breast cancer.In clinical practice,it’s relatively convenient to get the numbers of neutrophils and lymphocytes from peripheral blood samples.Now,majority of studies are designed focusing on the relationship between preoperative NLR(preNLR)levels and clinical features of the patients.Rarely few studies have explored the postoperative NLR(postNLR)and neutrophil-to-lymphocyte ratio change(NLRc).In this paper,we summarized both the postNLR and NLRc as well as the preNLR,and tried to analyze its relationship with the prognosis of breast cancer patients with different tumor pathological features.Methods:A total of 146 patients diagnosed with breast infiltrating ductal carcinoma were selected randomly in this retrospective analysis and all the patients were hospitalized at the Second Hospital of Tianjin Medical University during January 2009 to January 2012.Fasting venous blood samples of patients were extracted in 6 of next morning after admission and 2 weeks after surgery respectively.The samples were sent to the laboratory for blood routine examination.Counts of neutrophil and lymphocyte were recorded on which the NLR and NLRc was calculated.By the application of receiver operating characteristic(ROC)curve,we selected the critical value taking into account the specificity and sensitivity.Then the patients were grouped based on the critical value,and the patients’ clinical pathological characteristics were used to evaluate its guiding effect on prognosis.We attempted to probe the value of NLR and NLRc in diffrient subtypes of breast cancer.Data were further analyzed by the statistical methods including logistic regression and Proportional hazards model.Results:By collecting and texting all the patients’ blood samples,Data of PreNLR,PostNLR,and NLRc was obtained and statistically analyzed in combination with the patient’s clinical characteristics and prognosis.The areas under the curve of Pre C,Pre L,Post N,and Post L fluctuated around 0.5,and were not accurate enough to diagnose the recurrence of breast cancer.However,PreNLR,PostNLR,and NLRc have a better diagnostic value for the recurrence.To a certain extent,PreNLR,PostNLR,NLRc can be used as a prognostic indicator in breast cancer.PreNLR and PostNLR was enough to play a guiding role in predicting PFS and OS of breast cancer patients.The difference were statistically significant(P<0.05,P<0.05).Unfortunately,because of the small sample size,NLRc was observed to display its value of diagnosis only in PFS of breast cancer patients(P<0.05),while in OS the P value was 0.16,the difference was not statistically significant.But,based on the trend of the survival curve of the patients,the prognosis of NLRc-negative patients was slightly better than that of NLRc-positive patients which indirectly proved the value of NLRc.Conclusions: 1.There is a close relationship between NLR and clinicopathological features of breast cancer patients.2.PreNLR and PostNLR can guide the prognosis of breast cancer patients to a certain extent,at the same time,NLRc may serve as a new index to help clinicians predict the prognosis of patients.3.The effects of PreNLR,PostNLR,and NLRc in predicting the prognosis of breast cancer patients still require extensive clinical trials to do further exploration.