Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer.
Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer.
复制标题
DOI：
10.1038/bjc.2015.183
复制
发表时间：
2015-06-30
影响因子：
8.8
通讯作者：
Taib NA
中科院分区：
文献类型：
--
作者：
Koh CH;Bhoo-Pathy N;Ng KL;Jabir RS;Tan GH;See MH;Jamaris S;Taib NA
外周血源性炎症评分，如中性粒细胞-淋巴细胞比率(NLR)和血小板-淋巴细胞比率(PLR)，最近被认为是实体瘤的预后标志。尽管支持这些标记物作为不良预后因素的证据在胃肠道癌症中更有说服力，但对它们对乳腺癌的影响知之甚少。我们调查了NLR和PLR之间的关系，以及乳腺癌后的总体生存率。研究数据来自马来亚大学医学中心乳腺癌登记处。在2000年至2008年连续诊断的2,059名患者中，我们纳入了1,435名治疗前血细胞计数可用的患者(∼为70%)。患者被分层为NLR/PLR的五分位数。采用多因素Cox回归分析NLR/PLR的独立预后意义。与NLR的前五分之一相比，五分之一的女性更年轻，有更大的肿瘤，淋巴结转移，远处转移和更高的肿瘤分级。5年相对生存率(RSR)分别为76.4%(95%CI：69.6-82.1%)、79.4%(95%CI：74.4-83.7%)、72.1%(95%CI：66.3-77.3%)。经人口学、肿瘤特征、治疗和PLR调整后，调整后的危险比(HR)为1.50(95%CI：1.08~1.63)；P趋势=0.004。当使用不同的截断点将NLR作为二分变量进行分析时，结果是不变的。尽管PLR五分位数为5的患者的存活率低于五分位数为1的患者(5年RSR：53.2%(95%可信区间：46.9-59.2%)对77.0%(95%可信区间：70.9-82.2%))，但经多因素调整后，这种相关性并不显著。然而，PLR>；185与较差的存活率显著相关；调整后的HR：1.25(95%CI：1.04-1.52)。NLR和PLR都独立地与乳腺癌死亡风险的增加有关。在临床实践中，它们在预测乳腺癌预后方面的价值值得研究。
Peripheral blood-derived inflammation-based scores such as the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) have recently been proposed as prognostic markers in solid tumours. Although evidence to support these markers as unfavourable prognostic factors is more compelling in gastrointestinal cancers, very little is known of their impact on breast cancer. We investigated the association between the NLR and PLR, and overall survival after breast cancer. Data from the University of Malaya Medical Centre Breast Cancer Registry was used. Of 2059 consecutive patients diagnosed from 2000 to 2008, we included 1435 patients with an available pre-treatment differential blood count (∼70%). Patients were stratified into quintiles of the NLR/PLR. Multivariable Cox regression was used to determine the independent prognostic significances of the NLR/PLR. Compared with the first quintile of the NLR, women in quintile 5 were younger, had bigger tumours, nodal involvement, distant metastases and higher tumour grades. Higher NLR quintiles were significantly associated with poorer survival with a 5-year relative survival ratio (RSR) of 76.4% (95% CI: 69.6–82.1%) in quintile 1, 79.4% (95% CI: 74.4–83.7%) in quintile 2, 72.1% (95% CI: 66.3–77.3%) in quintile 3, 65.6% (95% CI: 59.8–70.8%) in quintile 4 and 51.1% (95% CI: 43.3–58.5%) in quintile 5. Following adjustment for demography, tumour characteristics, treatment and the PLR, the adjusted hazard ratio (HR) for quintile 5 vs quintile 1 was 1.50 (95% CI: 1.08–1.63); Ptrend=0.004. Results were unchanged when the NLR was analysed as a dichotomous variable using different cutoff points. Although patients in PLR quintile 5 had lower survival than in quintile 1 (5-year RSR: 53.2% (95% CI: 46.9–59.2%) vs 77.0% (95% CI: 70.9–82.2%)), this association was not significant after multivariable adjustment. However, a PLR >185 was significantly associated with poorer survival; adjusted HR: 1.25 (95% CI: 1.04–1.52). Both the NLR and PLR are independently associated with an increased risk of mortality in breast cancer. Their added value in the prognostication of breast cancer in clinical practice warrants investigation.