Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients.

Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Annals of Surgical Oncology (Impact Factor: 3.94). 06/2011; 19(1):217-24. DOI: 10.1245/s10434-011-1814-0
Source: PubMed

ABSTRACT The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients with colorectal, gastric, hepatocellular, pancreatic, and lung cancer. To date, the utility of NLR to predict mortality in breast cancer patients has not been studied. Therefore, the aim of our study was to determine whether the NLR is predictive of short- and long-term mortality in breast cancer patients.
Our observational study used an unselected cohort of breast cancer patients treated at the Staten Island University Hospital between January 2004 and December 2006. A total of 316 patients had a differential leukocyte count recorded prior to chemotherapy. Survival status was retrieved from our cancer registry and Social Security death index. Survival analysis, stratified by NLR quartiles, was used to evaluate the predictive value of NLR.
Patients in the highest NLR quartile (NLR > 3.3) had higher 1-year (16% vs 0%) and 5-year (44% vs 13%) mortality rates compared with those in the lowest quartile (NLR < 1.8) (P < .0001). Those in the highest NLR quartile were statistically significantly older and had more advanced stages of cancer. After adjusting for the factors affecting the mortality and/or NLR (using two multivariate models), NLR level > 3.3 remained an independent significant predictor of mortality in both models (hazard ratio 3.13, P = .01) (hazard ratio 4.09, P = .002).
NLR is an independent predictor of short- and long-term mortality in breast cancer patients with NLR > 3.3. We suggest prospective studies to evaluate the NLR as a simple prognostic test for breast cancer.

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    ABSTRACT: Introduction Several studies reported the negative impact of elevated neutrophil/lymphocyte ratio (NLR) on outcomes in many surgical and medical conditions. Previous studies used arbitrary NLR cut-off points according to the average of the populations under study. There is no data on the average NLR in the general population. The aim of this study is to explore the average values of NLR and according to race in adult non-institutional United States individuals by using national data. Methods The National Health and Nutrition Examination Survey (NHANES) of aggregated cross-sectional data collected from 2007 to 2010 was analyzed; data extracted included markers of systemic inflammation (neutrophil count, lymphocyte count, and NLR), demographic variables and other comorbidities. Subjects who were prescribed steroids, chemotherapy, immunomodulators and antibiotics were excluded. Adjusted linear regression models were used to examine the association between demographic and clinical characteristics and neutrophil counts, lymphocyte counts, and NLR. Results Overall 9427 subjects are included in this study. The average value of neutrophils is 4.3k cells/mL, of lymphocytes 2.1k cells/mL; the average NLR is 2.15. Non-Hispanic Black and Hispanic participants have significantly lower mean NLR values (1.76, 95% CI 1.71–1.81 and 2.08, 95% CI 2.04–2.12 respectively) when compared to non-Hispanic Whites (2.24, 95% CI 2.19–2.28–p<0.0001). Subjects who reported diabetes, cardiovascular disease, and smoking had significantly higher NLR than subjects who did not. Racial differences regarding the association of smoking and BMI with NLR were observed. Conclusions This study is providing preliminary data on racial disparities in a marker of inflammation, NLR, that has been associated with several chronic diseases outcome, suggesting that different cut-off points should be set according to race. It also suggests that racial differences exist in the inflammatory response to environmental and behavioral risk factors.
    PLoS ONE 11/2014; 9(11):e112361. DOI:10.1371/journal.pone.0112361 · 3.53 Impact Factor
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    ABSTRACT: Aims: The aim of this study was to examine the correlation, if any, between the preoperative neutrophil/lymphocyte ratio (NLR) and the OncotypeDX™ 21-gene recurrence score (RS) in patients with early-stage estrogen receptor (ER)-positive breast cancer (BC). Materials and Methods: We retrospectively reviewed the medical records of patients diagnosed with primary ER-positive BC who were referred for the RS assay. The correlation between the preoperative NLR and the RS was analyzed. Results: For the 242 patients with sufficient data for analysis, the median age at diagnosis was 59.5 years. The tumor size ranged from 0.50 to 5.50 cm, with a mean size of 1.8 cm; 73.2% of the tumors were < 2 cm in size. Most of the tumors (66.3%) were of grade 2; the rest was nearly equally divided between grades 1 and 3. The test results for the progesterone receptor (PR) were positive in 86.6% of the cases. Lymph node metastases were present in 22.3% of the patients. The median RS was 18 (range 0-60) and the mean NLR value was 2.11 (range 0.49-7.49). We found no significant correlation between the NLR and the RS. Conclusion: Our data suggest that the preoperative NLR does not predict the 21-gene RS in patients with early-stage hormone-sensitive BC. © 2015 S. Karger GmbH, Freiburg.
    01/2015; DOI:10.1159/000370341
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    ABSTRACT: IntroductionThe neutrophil-to-lymphocyte ratio (NLR) is a biological marker that has been shown to be associated with outcomes in patients with a number of different malignancies. The objective of this study was to assess the relationship between NLR and mortality in a population of adult critically ill patients.Methods We performed an observational cohort study of unselected intensive care unit (ICU) patients using a large clinical database. We computed individual patient NLR and categorized patients by quartile of this ratio. The association of NLR quartiles and 28-day mortality was assessed using multivariable logistic regression. Secondary outcomes included mortality in the ICU, in-hospital mortality and 1-year mortality. An a priori sub-group analysis of patients with and without sepsis was performed to assess any differences in the relationship between the NLR and outcomes in these cohorts.ResultsA total of 5,056 patients were included with a 28-day mortality rate of 19%. The median age of the cohort was 65 years and 47% were female. The median NLR for the entire cohort was 8.9 (interquartile range: 4.99 to 16.21). Following multivariable adjustments, there was a stepwise increase in mortality with increasing quartiles of NLR (1st quartile: reference category; 2nd quartile odds ratio (OR)¿=¿1.36, 95% confidence interval (CI): 1.06 to 1.74; 3rd quartile OR¿=¿1.47, 95% CI: 1.15 to 1.89; 4th quartile OR 1.78, 95% CI: 1.41 to 2.25). A similar stepwise relationship was identified in the subgroup of patients who presented without sepsis. The NLR was not associated with 28-day mortality in patients with sepsis. Increasing quartile of NLR was statistically significantly associated with secondary outcomes.Conclusion The neutrophil-to-lymphocyte ratio is associated with outcomes in unselected critically ill patients. In patients with sepsis there was no statistically significant relationship between NLR and mortality. Further investigation is required to understand the pathophysiology of this relationship and to validate these findings with data collected prospectively.
    Critical care (London, England) 01/2015; 19(1):13. DOI:10.1186/s13054-014-0731-6


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