title: Pre-treatment neutrophil to lymphocyte ratio may be a useful tool in predicting survival in early triple negative breast cancer patients.
abstract: BACKGROUND
  There is a growing body of evidence that immune response plays a large role in cancer outcome. The neutrophil to lymphocyte ratio (NLR) has been used as a simple parameter of systemic inflammation in several tumors. The purpose was to investigate the association between pre-treatment NLR, disease-free survival and overall survival in patients with early triple negative breast cancer (TNBC).
  
  
  METHODS
  We reviewed the records of patients with stage I-III TNBC at our Institution from 2006 to 2012. The association between pre-treatment NLR and survival was analyzed. The difference among variables was calculated by chi-square test. DFS and OS were estimated using Kaplan-Meier method. Cox analysis was performed to analyze clinical parameters for their prognostic relevance.
  
  
  RESULTS
  A total of 90 patients were eligible. There was no significant correlation among pre-treatment NLR and various clinical pathological factors. Patients with NLR higher than 3 showed significantly lower DFS (p = 0.002) and OS (p = 0.009) than patients with NLR equal or lower than 3. The Cox proportional multivariate hazard model revealed that higher pre-treatment NLR was independently correlated with poor DFS and OS, with hazard ratio 5.15 (95% confidence interval [CI] 1.11-23.88, p = 0.03) and 6.16 (95% CI 1.54-24.66, p = 0.01) respectively.
  
  
  CONCLUSIONS
  Our study suggests that pre-treatment NLR may be associated with DFS and OS patients with early TNBC. Further validation and a feasibility study are required before it can be considered for clinical use.
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. mirco.pistelli@alice.it.
authors.forename: Mirco
authors.initials: M
authors.lastname: Pistelli
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. mgrazia.delisa@gmail.com.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: De Lisa
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. zelmira.ballatore@gmail.com.
authors.forename: Zelmira
authors.initials: Z
authors.lastname: Ballatore
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. miriam.caramanti@libero.it.
authors.forename: Miriam
authors.initials: M
authors.lastname: Caramanti
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. alessandrapagliacci@virgilio.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pagliacci
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. battellin@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Battelli
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. francesca.ridolfi1@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ridolfi
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. mattymo@alice.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. elena.maccaroni@live.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Maccaroni
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. raffaellabracci@libero.it.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bracci
authors.affiliation: Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy. a.santinelli@univpm.it.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Santinelli
authors.affiliation: Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy. biscottit@libero.it.
authors.forename: Tommasina
authors.initials: T
authors.lastname: Biscotti
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. r.berardi@univpm.it.
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy. cascinu@yahoo.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D018270:Carcinoma, Ductal, Breast / Q000276:immunology* / Q000401:mortality / Q000556:secondary / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000276:immunology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D064726:Triple Negative Breast Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy