Prognostic value of peripheral blood neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in breast cancer patients receiving neoadjuvant chemotherapy

Objective To evaluate the relationship of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with disease-free survival (DFS) in breast cancer patients who received neoadjuvant chemotherapy (NAC). Methods We retrospectively analyzed the clinical data of 283 breast cancer patients with NAC in the First Affiliated Hospital of Chongqing Medical University from January 2013 to March 2015. Cutoff values of NLR and PLR were estimated by Yoden index, and the patients were divided into high or low ratio group according to cutoff values. The correlation of DFS with peripheral blood NLR and PLR was analyzed by Log-rank test and Cox's proportional hazard regression model. Results The values of NLR and PLR corresponding to the maximum Yoden index were 1.8 and 130.0 respectively, regarded as cutoff values. Accordingly, there were 180 patients in high NLR group (≥1.8) and 103 patients in low NLR group (<1.8); there were 130 patients in high PLR group (≥130.0) and 153 patients in low PLR group (<130.0). With a median follow-up of 30 months (range: 5 to 46 months), the median DFS in high NLR group was significantly shorter than that in low NLR group (27.0 months vs 34.0 months, Log-rank test: χ2=26.25, P<0.001). The median DFS in high PLR group was significantly shorter than that in low PLR group (27.5 months vs 32.0 months, Log-rank test: χ2=28.32, P<0.001). Totally 239 patients had not achieved pCR after NAC. Among them, high NLR group (n=161) had a significantly worse DFS than low NLR group (n=78) (HR=2.84, 95%CI=1.43-4.45, P=0.002); the high PLR group (n=118) had a significantly worse DFS than low PLR group (n=121) (HR=2.62, 95%CI=1.51-4.61, P=0.001). Cox's proportional hazard regression analysis showed that childbirth history (HR=3.90, 95%CI=1.282-11.874, P=0.016) and high PLR (HR=1.010, 95%CI=1.003-1.017, P=0.004) were significantly associated with DFS in breast cancer patients with NAC, but high NLR was not an independent prognostic factor. Conclusion High PLR and NLR in peripheral blood of breast cancer patients before treatment predict a poor prognosis after NAC, and PLR is an independent risk factor. Key words: Breast neoplasms; Prognosis; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Neoadjuvant chemotherapy