title: Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1] Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia [2] Department of Surgery, Hospital Tengku Ampuan Afzan, Jalan Besar, 25100 Kuantan, Pahang, Malaysia.
authors.forename: C-H
authors.initials: CH
authors.lastname: Koh
authors.affiliation: 1] Julius Center University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia [2] National Clinical Research Centre, Hospital Kuala Lumpur, Level 3, Dermatology Block, 50586 Jalan Pahang, Kuala Lumpur, Malaysia [3] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: K-L
authors.initials: KL
authors.lastname: Ng
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: R S
authors.initials: RS
authors.lastname: Jabir
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: G-H
authors.initials: GH
authors.lastname: Tan
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: M-H
authors.initials: MH
authors.lastname: See
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Jamaris
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: N A
authors.initials: NA
authors.lastname: Taib
mesh_terms: D001792:Blood Platelets / Q000473:pathology*; D001943:Breast Neoplasms / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis