Deconstructing neutrophil to lymphocyte ratio (NLR) in early breast cancer: lack of prognostic utility and biological correlates across tumor subtypes

Esmeralda Garcia-Torralba; Miguel Pérez Ramos; Alejandra Ivars Rubio; Esther Navarro Manzano; Noel Blaya Boluda; Miguel Lloret Gil; Alberto Aller; Pilar de la Morena Barrio; Elisa García Garre; Francisco Martínez Díaz; Francisco García Molina; Asunción Chaves Benito; Elena García-Martínez; Francisco Ayala de la Peña

doi:10.1007/s10549-024-07286-x

Deconstructing neutrophil to lymphocyte ratio (NLR) in early breast cancer: lack of prognostic utility and biological correlates across tumor subtypes

Breast Cancer Res Treat. 2024 Mar 7. doi: 10.1007/s10549-024-07286-x. Online ahead of print.

Authors

Esmeralda Garcia-Torralba^{1

2

3}, Miguel Pérez Ramos⁴, Alejandra Ivars Rubio^{1

2

3}, Esther Navarro Manzano^{1

3

5}, Noel Blaya Boluda^{1

2

3}, Miguel Lloret Gil², Alberto Aller², Pilar de la Morena Barrio^{1

3}, Elisa García Garre^{1

3}, Francisco Martínez Díaz^{3

6

7}, Francisco García Molina^{6

7}, Asunción Chaves Benito^{4

7}, Elena García-Martínez^{1

3

8}, Francisco Ayala de la Peña⁹

Affiliations

¹ Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain.
² Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain.
³ Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain.
⁴ Department of Pathology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain.
⁵ Centro Regional de Hemodonación, Murcia, 30003, Spain.
⁶ Department of Pathology, Hospital Universitario Reina Sofía, Murcia, 30003, Spain.
⁷ Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain.
⁸ Medical School, Universidad Católica San Antonio, Murcia, 30107, Spain.
⁹ Department of Medical Oncology, School of Medicine, Hospital Universitario Morales Meseguer, University of Murcia, Avda. Marqués de los Vélez, s/n, Murcia, 30008, Spain. frayala@um.es.

PMID: 38453782
DOI: 10.1007/s10549-024-07286-x

Abstract

Purpose: The prognostic utility and biological correlates of neutrophil to lymphocyte ratio (NLR), a potential biomarker of the balance between immune response and the inflammatory status, are still uncertain in breast cancer (BC).

Methods: We analysed a cohort of 959 women with early breast cancer, mostly treated with neoadjuvant or adjuvant chemotherapy. Clinical and pathological data, survival, NLR (continuous and categorical) and stromal tumor infiltrating lymphocytes (sTIL) were evaluated.

Results: NLR was only weakly associated with Ki67, while no association was found for grade, histology, immunohistochemical subtype or stage. Lymphocyte infiltration of the tumor did not correlate with NLR (Rho: 0.05, p = 0.30). These results were similar in the whole group and across the different BC subtypes, with no differences in triple negative BC. Relapse free interval (RFI), breast cancer specific survival (BCSS) and overall survival (OS) changed according to pre-treatment NLR neither in the univariate nor in the multivariate Cox models (RFI: HR 0.948, p = 0.61; BCSS: HR 0.920, p = 0.57; OS: HR 0.96, p = 0.59).

Conclusion: These results question the utility of NLR as a prognostic biomarker in early breast cancer and suggest the lack of correlation of NLR with tumor microenvironment immune response.

Keywords: Early breast cancer; Neutrophil-to-lymphocyte ratio; Prognosis; Tumor infiltrating lymphocytes.