Department of Breast and General Surgery, Cork University Hospital, Cork, Ireland.
Department of General Surgery, University Hospital Kerry, Kerry, Ireland.
Clin Breast Cancer. 2020 Dec;20(6):e675-e681. doi: 10.1016/j.clbc.2020.05.008. Epub 2020 May 16.
The systemic inflammatory response plays a role in tumor progression and development. The neutrophil to lymphocyte ratio (NLR) is a biochemical marker of systemic inflammation and is increasingly gaining appreciation for its prognostic role in predicting breast cancer outcomes. Previous research has demonstrated that patients who achieve a complete pathologic response (pCR) to neoadjuvant breast cancer treatment have a more favorable disease-free survival. This study aimed to assess whether the NLR can predict pCR to neoadjuvant therapy in breast cancer. A meta-analysis of 8 relevant studies was performed. The primary endpoint included pCR. Secondary endpoint included 5-year disease-free survival. Eight studies were included, reporting on 1586 patients. A total of 363 (22.88%) patients achieved pCR post neoadjuvant therapy. A lower NLR was associated with a greater rate of pCR (odds ratio, 1.83; 95% confidence interval, 1.15-2.91; P = .0003). Only 4 studies produced data on disease-free survival. A lower NLR was associated with a higher 5-year disease-free survival; however, this did not achieve statistical significance (hazard ratio, 1.38; 95% confidence interval, 0.82-2.31; P = .02). Sub-group analysis of sample size, NLR value, and geographic location proved statistically significant in determining an association between NLR and pCR. This meta-analysis found NLR to be a predictor for pCR in patients with breast cancer. All of the studies reviewed were retrospective cohort studies. Adequately sized, prospective clinical trials are needed to understand if NLR could become an important prognostic indicator of pCR.
全身炎症反应在肿瘤的发生和发展中起作用。中性粒细胞与淋巴细胞比值（NLR）是全身炎症的生化标志物，其在预测乳腺癌结局方面的预后作用越来越受到重视。先前的研究表明，接受新辅助乳腺癌治疗后达到完全病理缓解（pCR）的患者具有更有利的无病生存。本研究旨在评估 NLR 是否可以预测新辅助治疗中乳腺癌的 pCR。对 8 项相关研究进行了荟萃分析。主要终点包括 pCR。次要终点包括 5 年无病生存率。纳入了 8 项研究，共报告了 1586 例患者。共有 363 例（22.88%）患者在新辅助治疗后达到 pCR。NLR 越低，pCR 率越高（比值比，1.83；95%置信区间，1.15-2.91；P =.0003）。只有 4 项研究提供了无病生存的数据。NLR 越低，5 年无病生存率越高；然而，这并未达到统计学意义（风险比，1.38；95%置信区间，0.82-2.31；P =.02）。亚组分析样本量、NLR 值和地理位置在确定 NLR 与 pCR 之间的关联方面具有统计学意义。这项荟萃分析发现 NLR 是乳腺癌患者 pCR 的预测因子。所有纳入的研究均为回顾性队列研究。需要进行足够规模的前瞻性临床试验，以了解 NLR 是否可以成为 pCR 的重要预后指标。
