Prognostic role for the derived neutrophil-to-lymphocyte ratio in early breast cancer: a GEICAM/9906 substudy

• A. J. Templeton ^[1] ; Á. Rodríguez-Lescure ^[2] ; A. Ruíz ^[3] ; E. Alba ^[3] ; L. Calvo ^[3] ; M. Ruíz-Borrego ^[3] ; A. Santaballa ^[3] ; C. A. Rodríguez ^[3] ; C. Crespo ^[3] ; M. Ramos ^[3] ; J. M. Gracia-Marco ^[3] ; A. LluchI. Álvarez ^[3] ; M. I. Casas ^[3] ; M. Sánchez-Aragó ^[3] ; R. Caballero ^[3] ; E. Carrasco ^[3] ; E. Amir ^[4] ; M. Martin ^[3] ; A. Ocaña ^[3]
  1. [1] St. Claraspital. Basel, Switzerland
  2. [2] Hospital Universitario de Elche
  3. [3] GEICAM (Spanish Breast Cancer Group), Madrid
  4. [4] Princess Margaret Cancer Centre. Toronto, Canada

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 20, Nº. 12, 2018, págs. 1548-1556
• Idioma: inglés
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• Resumen

  • Purpose Elevated markers of host inflammation, a hallmark of cancer, have been associated with worse outcomes in several solid tumors. Here, we explore the prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR), across different tumor subtypes, in patients with early breast cancer.

    Patients and methods This was a retrospective analysis of 1246 patients with lymph node-positive, operable early breast cancer enrolled in the GEICAM/9906 trial, a multicenter randomized phase 3 study evaluating adjuvant chemotherapy. dNLR was calculated as the ratio of neutrophils and the difference between total leukocytes and neutrophils in peripheral blood before chemotherapy. Disease-free survival (DFS) and overall survival were explored using a Cox proportional hazard analysis.

    Results The analysis comprised 1243 (99.8%) patients with dNLR data, with a median follow-up of 10 years. Data on intrinsic subtypes were available from 818 (66%) patients (luminal A 34%, luminal B 32%, HER2-enriched 21% and basal-like 9%). Median dNLR was 1.35 [interquartile range (IQR) 1.08–1.71]. In the whole population, dNLR was not prognostic after adjustment for clinico-pathological factors. However, dNLR ≥ 1.35 was independently associated with worse DFS in the hormone receptor-negative/HER2+ population (HR 2.86; p = 0.038) and in patients with one to three lymph node metastases (HR 1.32, p = 0.032). There was a non-significant association with worse DFS in non-luminal and in HER2-enriched tumors (HR 1.40, p = 0.085 and HR 1.53, p = 0.067). No significant interaction was observed between the treatment arm and dNLR.

    Conclusion Elevated dNLR appears to be an adverse prognostic factor in hormone receptor-negative early breast cancer.

    Trial registration EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). ClinicalTrials.gov Identifier: NCT00129922 (retrospectively registered 10/08/2005). Results of this study were presented in part at the 2016 ESMO conference October 7–11, 2016, Copenhagen, Denmark (oral presentation).