Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis.
Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis.
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DOI：
10.1136/esmoopen-2016-000038
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发表时间：
2016
期刊：
影响因子：
7.3
通讯作者：
Ciardiello F
中科院分区：
文献类型：
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作者：
Orditura M;Galizia G;Diana A;Saccone C;Cobellis L;Ventriglia J;Iovino F;Romano C;Morgillo F;Mosca L;Diadema MR;Lieto E;Procaccini E;De Vita F;Ciardiello F
评估早期乳腺癌患者术前中性粒细胞/淋巴细胞比值（NLR）与无远处转移生存期（DMFS）的相关性。回顾性分析。1999年7月至2015年6月在我们机构随访的300例早期（T1-2，N 0 -1，非转移性）乳腺癌白人患者。无远处转移生存期（DMFS）。在整个人群（300例患者）中，根据受试者工作特征（ROC）曲线分析（曲线下面积（AUC）=0.625，p=0.0160）确定的NLR值1.97，分别将134例和166例患者分为低NLR和高NLR。低NLR患者的1、3、6、9、12和15年DMFS率较好（分别为100%、98.9%、91.7%、82.7%、82.7%、82.7%），高于高NLR患者（分别为99.4%、94.3%、84.5%、69.2%、66.0%、51.4%），具有统计学显著相关性。多变量分析显示，绝经前状态（HR=2.78，95% CI 1.36至5.67，p=0.0049），N1期（HR=2.31，95% CI 1.16 - 4.60，p=0.0167）和高NLR值（HR=2.64，95%CI 1.22 ~ 5.638，p=0.0133）是与不良复发率相关的独立预后因素。为了避免混杂偏倚的风险，进行了倾向评分匹配分析，并根据考克斯模型进行了多变量分析，证实了绝经前状态（HR=2.94，95% CI 1.25至6.93，p=0.0136），N1期（HR=2.77，95% CI 1.25至6.12，p=0.0117）和高NLR值（HR=2.52，95% CI 1.11至5.73，p=0.0271）作为预后较差的独立预后变量。据我们所知，这是第一项通过倾向评分匹配分析显示白人早期乳腺癌患者高NLR与预后不良之间显著相关的研究。需要进一步设计良好的大样本量前瞻性试验来验证我们的研究结果，并证明在临床实践中引入NLR评估来预测癌症复发是合理的。
To assess the correlation between presurgery neutrophil to lymphocyte ratio (NLR) and distant metastasis-free survival (DMFS) in patients with early breast cancer. Retrospective analysis. 300 Caucasian patients with early (T1–2, N0–1, non-metastatic) breast cancer who were followed from July 1999 to June 2015 at our Institution. Distant metastasis-free survival (DMFS). Of whole populations (300 patients), 134 and 166 patients were grouped as low and high NLR, respectively, on the basis of NLR value of 1.97, as established by receiver operating characteristic (ROC) curve analysis (area under curve (AUC)=0.625, p=0.0160). The DMFS rates for 1, 3, 6, 9, 12 and 15 years were better in low NLR patients (100%, 98.9%, 91.7%, 82.7%, 82.7%, 82.7%, respectively), than in high NLR patients (99.4%, 94.3%, 84.5%, 69.2%, 66.0%, 51.4%, respectively), with a statistically significant association. On multivariate analysis, premenopausal status (HR=2.78, 95% CI 1.36 to 5.67, p=0.0049), N1 stage (HR=2.31, 95% CI 1.16 to 4.60, p=0.0167) and a high NLR value (HR=2.64, 95% CI 1.22 to 5.638, p=0.0133) were shown to be independent prognostic factors related to poor recurrence rate. To avoid risk of confounding bias, a propensity score-matched analysis was performed and multivariate analysis according to the Cox model confirmed premenopausal status (HR=2.94, 95% CI 1.25 to 6.93, p=0.0136), N1 stage (HR=2.77, 95% CI 1.25 to 6.12, p=0.0117) and high NLR values (HR=2.52, 95% CI 1.11 to 5.73, p=0.0271), as independent prognostic variables of worse outcome. This is the first study, to our knowledge, to show a significant correlation between high NLR and worse prognosis in Caucasian patients with early breast cancer by means of propensity score-matched analysis. Further well designed prospective trials with a large sample size are needed to verify our findings and to justify introducing NLR assessment in clinical practice for prediction of cancer recurrence.