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Clinical and Translational Oncology

, Volume 21, Issue 7, pp 855–863 | Cite as

Pretreatment neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, and neutrophil/monocyte ratios and outcome in elderly breast cancer patients

  • B. LosadaEmail author
  • J. A. Guerra
  • D. Malón
  • C. Jara
  • L. Rodriguez
  • S. Del BarcoEmail author
Research Article
  • 178 Downloads

Abstract

Purpose

Several studies have found an association between peripheral inflammatory cells and outcome. However, no study has explored their impact specifically in elderly patients. We have retrospectively examined pretreatment peripheral neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and neutrophil/monocyte ratio (NMR) in 113 elderly breast cancer patients and correlated our findings with disease-free survival (DFS) and overall survival (OS).

Methods

All patients ≥ 65 years diagnosed from 2004 to 2018 with locally advanced breast cancer were included and classified as high vs low NLR, PLR, LMR, and NMR based on previously identified cutoffs. Estimated 1-, 3-, and 5-year DFS and OS were compared by Chi square analysis.

Results

Among 104 evaluable patients, only PLR was significantly associated with estimated 3-year DFS (85.1% vs 63.6%; P = 0.04) and OS (89.3% vs 68.1%; P = 0.03). Among 69 patients with three or more years of follow-up, PLR (P = 0.05), absolute lymphocyte count (ALC) (P = 0.01), polychemotherapy (P = 0.04), number of comorbidities (P = 0.02), polypharmacy (P = 0.005), and clinical stage (P = 0.03) were associated with 3-year DFS. Polypharmacy (OR 4.9; P = 0.02) and ALC (OR 4.6; P = 0.04) retained their significance in the multivariate analysis.

Conclusions

We have found an association between low PLR and longer DFS in elderly breast cancer patients that is in line with findings in patients with a wider range of ages. Our findings on NLR contrast with those of other studies, indicating a potential differential effect in elderly patients. In addition, the effect of polypharmacy on outcome in elderly patients warrants further investigation.

Keywords

Breast cancer Neutrophil-to-lymphocyte ratio Platelet-to-lymphocyte ratio Elderly Polypharmacy 

Notes

Funding

This study received no outside funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics and Clinical Research Committees of Fuenlabrada University Hospital and Alcorcon Foundation and was, therefore, performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study formal consent is not required.

Supplementary material

12094_2018_1999_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)

References

  1. 1.
    Cortazar P, Geyer CE Jr. Pathological complete response in neoadjuvant treatment of breast cancer. Ann Surg Oncol. 2015;22:1441–6.CrossRefGoogle Scholar
  2. 2.
    West NR, Milne K, Truong PT, Macpherson N, Nelson BH, Watson PH. Tumor-infiltrating lymphocytes predict response to anthracycline-based chemotherapy in estrogen receptor-negative breast cancer. Breast Cancer Res. 2011;13:R126.CrossRefGoogle Scholar
  3. 3.
    Ownby HE, Roi LD, Isenberg RR, Brennan MJ. Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer. 1983;52:126–30.CrossRefGoogle Scholar
  4. 4.
    Qian Y, Tao J, Li X, Chen H, Lu Q, Yang J, et al. Peripheral inflammation/immune indicators of chemosensitivity and prognosis in breast cancer patients treated with neoadjuvant chemotherapy. Onco Targets Ther. 2018;11:1423–32.CrossRefGoogle Scholar
  5. 5.
    Sun H, Yin CQ, Liu Q, Wang F, Yuan CH. Clinical significance of routine blood test-associated inflammatory index in breast cancer patients. Med Sci Monit. 2017;23:5090–5.CrossRefGoogle Scholar
  6. 6.
    Salazar-Onfray F, Lopez MN, Mendoza-Naranjo A. Paradoxical effects of cytokines in tumor immune surveillance and tumor immune escape. Cytokine Growth Factor Rev. 2007;18:171–82.CrossRefGoogle Scholar
  7. 7.
    Augier S, Ciucci T, Luci C, Carle GF, Blin-Wakkach C, Wakkach A. Inflammatory blood monocytes contribute to tumor development and represent a privileged target to improve host immunosurveillance. J Immunol. 2010;185:7165–73.CrossRefGoogle Scholar
  8. 8.
    Tang X. Tumor-associated macrophages as potential diagnostic and prognostic biomarkers in breast cancer. Cancer Lett. 2013;332:3–10.CrossRefGoogle Scholar
  9. 9.
    Zhang M, Huang XZ, Song YX, Gao P, Sun JX, Wang ZN. High platelet-to-lymphocyte ratio predicts poor prognosis and clinicopathological characteristics in patients with breast cancer: a meta-analysis. Biomed Res Int. 2017;2017:9503025.Google Scholar
  10. 10.
    Marin Hernandez C, Pinero Madrona A, Gil Vazquez PJ, Galindo Fernandez PJ, Ruiz Merino G, Alonso Romero JL, et al. Usefulness of lymphocyte-to-monocyte, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratios as prognostic markers in breast cancer patients treated with neoadjuvant chemotherapy. Clin Transl Oncol. 2018;20:476–83.CrossRefGoogle Scholar
  11. 11.
    Jia W, Wu J, Jia H, Yang Y, Zhang X, Chen K, et al. The peripheral blood neutrophil-to-lymphocyte ratio is superior to the lymphocyte-to-monocyte ratio for predicting the long-term survival of triple-negative breast cancer patients. PLoS One. 2015;10:e0143061.CrossRefGoogle Scholar
  12. 12.
    Yao M, Liu Y, Jin H, Liu X, Lv K, Wei H, et al. Prognostic value of preoperative inflammatory markers in Chinese patients with breast cancer. Onco Targets Ther. 2014;7:1743–52.Google Scholar
  13. 13.
    Noh H, Eomm M, Han A. Usefulness of pretreatment neutrophil to lymphocyte ratio in predicting disease-specific survival in breast cancer patients. J Breast Cancer. 2013;16:55–9.CrossRefGoogle Scholar
  14. 14.
    Templeton AJ, Rodriguez-Lescure A, Ruiz A, Alba E, Calvo L, Ruiz-Borrego M, et al. Prognostic role for the derived neutrophil-to-lymphocyte ratio in early breast cancer: a GEICAM/9906 substudy. Clin Transl Oncol 2018;20:1548.CrossRefGoogle Scholar
  15. 15.
    Asano Y, Kashiwagi S, Onoda N, Noda S, Kawajiri H, Takashima T, et al. Platelet-lymphocyte ratio as a useful predictor of the therapeutic effect of neoadjuvant chemotherapy in breast cancer. PLoS One. 2016;11:e0153459.CrossRefGoogle Scholar
  16. 16.
    Asano Y, Kashiwagi S, Onoda N, Noda S, Kawajiri H, Takashima T, et al. Predictive value of neutrophil/lymphocyte ratio for efficacy of preoperative chemotherapy in triple-negative breast cancer. Ann Surg Oncol. 2016;23:1104–10.CrossRefGoogle Scholar
  17. 17.
    Chen Y, Chen K, Xiao X, Nie Y, Qu S, Gong C, et al. Pretreatment neutrophil-to-lymphocyte ratio is correlated with response to neoadjuvant chemotherapy as an independent prognostic indicator in breast cancer patients: a retrospective study. BMC Cancer. 2016;16:320.CrossRefGoogle Scholar
  18. 18.
    Vernieri C, Mennitto A, Prisciandaro M, Huber V, Milano M, Rinaldi L, et al. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict efficacy of platinum-based chemotherapy in patients with metastatic triple negative breast cancer. Sci Rep. 2018;8:8703.CrossRefGoogle Scholar
  19. 19.
    Li C, Li J, Li Y, Lang S, Yougbare I, Zhu G, et al. Crosstalk between platelets and the immune system: old systems with new discoveries. Adv Hematol. 2012;2012:14.CrossRefGoogle Scholar
  20. 20.
    Vallet-Regi M, Manzano M, Rodriguez-Manas L, Checa Lopez M, Aapro M, Balducci L. Management of cancer in the older age person: an approach to complex medical decisions. Oncologist. 2017;22:335–42.CrossRefGoogle Scholar
  21. 21.
    Singh R, Hellman S, Heimann R. The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer. 2004;100:1807–13.CrossRefGoogle Scholar
  22. 22.
    Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005;55:241–52.CrossRefGoogle Scholar
  23. 23.
    Girones Sarrio R, Antonio Rebollo M, Molina Garrido MJ, Guillen-Ponce C, Blanco R, Gonzalez Flores E, et al. General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force’s position statement. Clin Transl Oncol. 2018;20:1246–51.CrossRefGoogle Scholar
  24. 24.
    Chen C, Sun P, Dai QS, Weng HW, Li HP, Ye S. The Glasgow Prognostic Score predicts poor survival in cisplatin-based treated patients with metastatic nasopharyngeal carcinoma. PLoS One. 2014;9:e112581.CrossRefGoogle Scholar
  25. 25.
    Ethier JL, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2017;19:2.CrossRefGoogle Scholar
  26. 26.
    Chen J, Pan Y, He B, Ying H, Sun H, Deng Q, et al. Meta-analysis of prognostic value of inflammation parameter in breast cancer. J Cancer Res Ther. 2018;14:S85–9.CrossRefGoogle Scholar
  27. 27.
    Nakano K, Hosoda M, Yamamoto M, Yamashita H. Prognostic significance of pre-treatment neutrophil: lymphocyte ratio in Japanese patients with breast cancer. Anticancer Res. 2014;34:3819–24.Google Scholar
  28. 28.
    Wang X, Han H, Duan Q, Khan U, Hu Y, Yao X. Changes of serum albumin level and systemic inflammatory response in inoperable non-small cell lung cancer patients after chemotherapy. J Cancer Res Ther. 2014;10:1019–23.CrossRefGoogle Scholar
  29. 29.
    Golchin N, Frank SH, Vince A, Isham L, Meropol SB. Polypharmacy in the elderly. J Res Pharm Pract. 2015;4:85–8.CrossRefGoogle Scholar
  30. 30.
    Elomrani F, Zine M, Afif M, L’Annaz S, Ouziane I, Mrabti H, et al. Management of early breast cancer in older women: from screening to treatment. Breast Cancer (Dove Med Press). 2015;7:165–71.Google Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Hospital Universitario de FuenlabradaMadridSpain
  2. 2.Escuela Internacional de Doctorado Universidad Rey Juan CarlosMóstolesSpain
  3. 3.Fundación Hospital AlcorcónMadridSpain
  4. 4.Hospital Universitari Dr. Josep Trueta, ICO GironaGironaSpain

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