Prognostic Evaluation Value Of Neutrophil To Lymphocyte Ratio In Multifocal/Multicentric Breast Cancer Patients

BackgroundBreast cancer is the leading cause of cancer-related death for women and the incidence is increasing year by year.With the increasing incidence and the development of mammography and breast MRI,the detection rate of multifocal/multicentric breast cancer(MMBC)has increased significantly.Due to differences in the definition of MMBC,sampling methods of mastectomy specimens,or imaging examinations,the incidence of MMBC reported in different studies varies greatly(5.6%to 41%).Compared with unifocal breast cancer,MMBC is more aggressive with a higher rate of lymph node metastasis,a higher rate of local recurrence and distant metastasis and a worse prognosis.Recent researches on clinicopathological characteristics,treatment and prognosis of MMBC is far from satisfaction it is urgent to find a simple and reliable prognostic marker for risk stratification of MMBC patients and guide the clinical treatment strategy.Researches have shown that the body’s inflammatory response and immune status play an important role in the occurrence and development of tumors.As an indicator of the body’s inflammation and immunity,the neutrophil to lymphocyte ratio(NLR)has been reported to be related to the prognosis of breast cancer,colorectal cancer,hepatocellular carcinoma and prostate cancer.Recent researches on the relationship between NLR and breast cancer prognosis mostly focus on unifocal breast cancer.It is necessary to investigate the value of NLR in evaluating the prognosis of MMBC patients.ObjectiveIn this study,we investigate the value of NLR in the prognostic evaluation of MMBC patients.MethodsA total of 164 MMBC patients who were treated in the First Affiliated Hospital,Zhengzhou University from January 2013 to January 2015 were retrospectively enrolled.The NLR was calculated within 1 week before the initial treatment.The receiver operating characteristic(ROC)curve was used to determine the best cut-off value of NLR.Chi-square test was used to analyze the differences between NLR and clinicalpathological characteristics of patients.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was used to compare the survival of the two NLR groups.Cox proportional hazards regression model was performed to analyze independent prognostic factors of disease-free survival(DFS)and overall survival(OS)of MMBC patients.Results1.The median NLR of 164 patients was 1.935(1.14～12.57).According to the ROC curve,the cut-off value of NLR was 2.53,used the NLR as the test variable and DFS as the state variable.According to the cut-off value of NLR,the patients were divided into low NLR group(NLR<2.53,111 patients)and high NLR group(NLR≥2.53,53 patients).2.Relationship between NLR and clinicopathological characteristics:The tumor size(P=0.039)and clinical stage(P=0.041)in high NLR group were significantly different from those in low NLR group.3.Survival analysis:Survival curves showed that the 5-year DFS of low NLR group was higher than that of high NLR group,and the difference was significant(81%vs 57%,P=0.001),the 5-year OS of low NLR group was higher than that of high NLR group,and the difference was significant(92%vs 67%,P=0.001).Univariate analysis showed that factors including the tumor size,lymph node metastasis,clinical stage,histological grade and NLR were significantly associated with DFS(all P<0.05);the expression status of estrogen receptor(ER),the tumor size,lymph node metastasis,histological grade and NLR were significantly associated with OS(all P<0.05).Further multivariate analysis showed that the tumor size(HR=4.250,95%CI:2.058～8.775,P<0.001),lymph node metastasis(HR=4.550,95%CI:1.907～10.856,P=0.001)and NLR(HR=2.055,95%CI:1.051～4.018,P=0.035)were independent predictors of DFS.The tumor size(HR=4.057,95%CI:1.411～11.666,P=0.009),lymph node metastasis(HR=3.929,95%CI:1.287～11.997,P=0.016),histological grade(HR=4.558,95%CI:1.048～19.827,P=0.043)and NLR(HR=2.675,95%CI:1.121～6.384,P=0.027)were independent predictors of OS.Conclusion1.Elevated NLR indicates larger tumor size,later clinical stage in MMBC patients.2.The NLR is an independent predictor of DFS and OS in MMBC patients.The NLR has a high value in predicting the prognosis of MMBC patients,suggesting that NLR can be used as one of important prognostic factors for MMBC patients.