Effectiveness of four inflammatory markers in predicting prognosis in 2374 women with breast cancer.

OBJECTIVE: To analyze the association between four biomarkers and overall survival in patients with breast cancer (BC).

METHODOLOGY: This cohort study had a sample of 2374 women over the age of 18, diagnosed and treated in a single reference center for BC in Brazil, during the year 2008-2009. The following pretreatment indices were analyzed: neutrophil-lymphocyte ratio (NLR), a derived neutrophil-lymphocyte ratio (dNLR), absolute neutrophil count (ANC) and platelet-lymphocyte ratio (PLR). A descriptive analysis was performed using median (range) and absolute and relative frequency as categorical variables. Exploratory survival evaluation was performed using the Kaplan-Meier method and the log-rank test for comparison between survival curves, with a statistical significance level of 5%. The variables with p<0.20 were selected for inclusion in a multivariate Cox regression model, considering as statistically significant p<0.05.

RESULTS: After adjusting for clinical variables, the biomarkers associated with worse overall survival were NLR >5 (HR=1.66 95%CI 1.08-2.55; p=0.021) and PLR >300 (HR=1.82 95%CI 1.10-2.99; p=0.019). When stratified by molecular subtype, the independent markers related to death were PLR >300 for triple negative (HR 3.27 95%CI 1.38-7.76; p=0.007); NLR >5 (HR 2.47 95%CI 1.16-5.28; p=0.019), ANC >7500 (HR 1.84 95%CI 1.17-2.90; p=0.008) and dNLR >3 (HR 2.45 95%CI 1.29-4.66; p=0.006) for luminal.

CONCLUSION: NLR and PLR are independent markers of prognosis in BC. Further studies are needed in patients with overexpression of HER 2.