Ethier Josee-Lyne, Desautels Danielle, Templeton Arnoud, Shah Prakesh S, Amir Eitan
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue 5-124, Toronto, ON, M5G 2M9, Canada.
Department of Medicine, University of Toronto, Toronto, Canada.
Breast Cancer Res. 2017 Jan 5;19(1):2. doi: 10.1186/s13058-016-0794-1.
The presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in several malignancies. Here, we quantify the effect of NLR on survival in patients with breast cancer, and examine the effect of clinicopathologic factors on its prognostic value.
A systematic search of electronic databases was conducted to identify publications exploring the association of blood NLR (measured pre treatment) and overall survival (OS) and disease-free survival (DFS) among patients with breast cancer. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance. Meta-regression was performed to evaluate the influence of clinicopathologic factors such as age, disease stage, tumor grade, nodal involvement, receptor status, and NLR cutoff on the HR for OS and DFS. All statistical tests were two-sided.
Fifteen studies comprising a total of 8563 patients were included. The studies used different cutoff values to classify high NLR (range 1.9-5.0). The median cutoff value for high NLR used in these studies was 3.0 amongst 13 studies reporting a HR for OS, and 2.5 in 10 studies reporting DFS outcomes. NLR greater than the cutoff value was associated with worse OS (HR 2.56, 95% CI = 1.96-3.35; P < 0.001) and DFS (HR 1.74, 95% CI = 1.47-2.07; P < 0.001). This association was similar in studies including only early-stage disease and those comprising patients with both early-stage and metastatic disease. Estrogen receptor (ER) and HER-2 appeared to modify the effect of NLR on DFS, because NLR had greater prognostic value for DFS in ER-negative and HER2-negative breast cancer. No subgroup showed an influence on the association between NLR and OS.
High NLR is associated with an adverse OS and DFS in patients with breast cancer with a greater effect on disease-specific outcome in ER and HER2-negative disease. NLR is an easily accessible prognostic marker, and its addition to established risk prediction models warrants further investigation.
中性粒细胞与淋巴细胞比值（NLR）升高与多种恶性肿瘤患者死亡率增加相关。在此，我们量化NLR对乳腺癌患者生存的影响，并研究临床病理因素对其预后价值的影响。
对电子数据库进行系统检索，以确定探讨乳腺癌患者血液NLR（治疗前测量）与总生存期（OS）及无病生存期（DFS）之间关联的出版物。将报告风险比（HR）和95%置信区间（CI）或P值的研究数据纳入荟萃分析。使用通用逆方差计算并加权合并HR。进行Meta回归以评估年龄、疾病分期、肿瘤分级、淋巴结受累情况、受体状态和NLR临界值等临床病理因素对OS和DFS的HR的影响。所有统计检验均为双侧检验。
纳入了15项研究，共8563例患者。这些研究使用不同的临界值来分类高NLR（范围为1.9 - 5.0）。在报告OS的HR的13项研究中，这些研究中使用的高NLR的中位数临界值为3.0，在报告DFS结果的10项研究中为2.5。高于临界值的NLR与较差的OS（HR 2.56，95% CI = 1.96 - 3.35；P < 0.001）和DFS（HR 1.74，95% CI = 1.47 - 2.07；P < 0.001）相关。在仅包括早期疾病的研究和包括早期及转移性疾病患者的研究中，这种关联相似。雌激素受体（ER）和HER-2似乎改变了NLR对DFS的影响，因为NLR在ER阴性和HER2阴性乳腺癌中对DFS具有更大的预后价值。没有亚组显示对NLR与OS之间的关联有影响。
高NLR与乳腺癌患者不良的OS和DFS相关，对ER和HER2阴性疾病的疾病特异性结局影响更大。NLR是一种易于获取的预后标志物，将其纳入已建立的风险预测模型值得进一步研究。
