title: Neutrophil to lymphocyte ratio (NLR) for prediction of distant metastasis-free survival (DMFS) in early breast cancer: a propensity score-matched analysis.
abstract: OBJECTIVE
  To assess the correlation between presurgery neutrophil to lymphocyte ratio (NLR) and distant metastasis-free survival (DMFS) in patients with early breast cancer.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  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.
  
  
  METHODS
  Distant metastasis-free survival (DMFS).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galizia
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Diana
authors.affiliation: Division of Breast Surgery, Medicina Futura Group, Naples, Napoli , Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Saccone
authors.affiliation: Division of Gynecology and Obstetrics, Department of Women, Children and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cobellis
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Jole
authors.initials: J
authors.lastname: Ventriglia
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iovino
authors.affiliation: Division of Internal Medicine, Allergy and Clinical Immunology, Department of Medical and Surgical Sciences , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Romano
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
authors.affiliation: Division of Gynecology and Obstetrics, Department of Women, Children and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mosca
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Diadema
authors.affiliation: Division of Surgical Oncology, Department of Anesthesiological, Surgical and Emergency Sciences , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Lieto
authors.affiliation: Breast Unit , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Procaccini
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.affiliation: Division of Medical Oncology, 'F Magrassi-A Lanzara' Department of Clinical and Experimental Medicine and Surgery , Second University of Naples School of Medicine , Naples , Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
keywords: early breast cancer; neutrophil to lymphocyte ratio; prognosis