Abstract
Purpose
Proinflammatory markers, including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), are associated with many aspects of different malignancies. The aim of this study was to assess the associations of NLR and PLR with estrogen receptor (ER) and progesterone receptor (PR) expression in locally advanced breast cancer patients and their changes after neoadjuvant chemotherapy (NAC). Whether these parameters were predictive for the response to NAC in breast cancer patients was also evaluated.
Methods
132 Female primary locally advanced breast cancer patients treated with either ET (epirubicin–docetaxel), TEC (docetaxel–epirubicin–cyclophosphamide), or CEF (cyclophosphamide–epirubicin–fluorouracil) as NAC were retrospectively studied. NLR and PLR were calculated from peripheral blood cell count and their optimal cutoff levels were determined by receiver operating characteristic curves.
Results
The proportion of ER-positive breast cancers before NAC was higher both in NLRlow (<2.05) group and PLRlow group (<159.01). Changes in ER or PR expression level or status were observed in some patients. The alterations of NLR and PLR after NAC correlated with chemotherapy regimens, and elevated PLR was found. The patients with low pretreatment NLR (<1.67) or PLR (<151.27) had better responses to NAC than those with high NLR (≥1.67, 67.3 vs. 47.1%, P < 0.05) or PLR (≥151.27, 64.0 vs. 45.1%, P < 0.05).
Conclusions
The patients with low pretreatment NLR (<2.05) or PLR (<159.01) had higher ER expression. Changes in ER and PR expression status or level occured following NAC. Elevated PLR was found aft-NAC. Pretreatment NLR and PLR may be important predictive indicators for NAC response in breast cancer patients.
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References
Sinacki M, Badzio A, Welnicka-Jaskiewicz M, Bogaerts J, Piccart MJ, Therasse P, et al. Pattern of care in locally advanced breast cancer: focus on local therapy. Breast. 2011;20(2):145–50. doi:10.1016/j.breast.2010.08.008.
Chavez-MacGregor M, Gonzalez-Angulo AM. Breast cancer, neoadjuvant chemotherapy and residual disease. Clin Transl Oncol. 2010;12(7):461–7. doi:10.1007/s12094-010-0538-0.
Mayer EL, Carey LA, Burstein HJ. Clinical trial update: implications and management of residual disease after neoadjuvant therapy for breast cancer. Breast Cancer Res. 2007;9(5):110. doi:10.1186/bcr1755.
Zhou X, Zhang J, Yun H, Shi R, Wang Y, Wang W, et al. Alterations of biomarker profiles after neoadjuvant chemotherapy in breast cancer: tumor heterogeneity should be taken into consideration. Oncotarget. 2015;6(34):36894–902. doi:10.18632/oncotarget.5050.
Cockburn A, Yan J, Rahardja D, Euhus D, Peng Y, Fang Y, et al. Modulatory effect of neoadjuvant chemotherapy on biomarkers expression; assessment by digital image analysis and relationship to residual cancer burden in patients with invasive breast cancer. Hum Pathol. 2014;45(2):249–58. doi:10.1016/j.humpath.2013.09.002.
Tomita M, Shimizu T, Ayabe T, Yonei A, Onitsuka T. Preoperative neutrophil to lymphocyte ratio as a prognostic predictor after curative resection for non-small cell lung cancer. Anticancer Res. 2011;31(9):2995–8.
Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Combination of platelet count and neutrophil to lymphocyte ratio is a useful predictor of postoperative survival in patients with colorectal cancer. Br J Cancer. 2013;109(2):401–7. doi:10.1038/bjc.2013.350.
Rossi L, Santoni M, Crabb SJ, Scarpi E, Burattini L, Chau C, et al. High neutrophil-to-lymphocyte ratio persistent during first-line chemotherapy predicts poor clinical outcome in patients with advanced urothelial cancer. Ann Surg Oncol. 2015;22(4):1377–84. doi:10.1245/s10434-014-4097-4.
Luo G, Guo M, Liu Z, Xiao Z, Jin K, Long J, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol. 2015;22(2):670–6. doi:10.1245/s10434-014-4021-y.
Ulas A, Avci N, Kos T, Cubukcu E, Olmez OF, Bulut N, et al. Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio associated with prognosis in patients with HER2-positive early breast cancer receiving adjuvant trastuzumab? J BUON. 2015;20(3):714–22.
Dede DS, Gumuskaya B, Guler G, Onat D, Altundag K, Ozisik Y. Evaluation of changes of biologic markers ER, PR, HER 2 and Ki-67 in breast cancer with administration of neoadjuvant dose-dense doxorubicin, cyclophosphamide followed by paclitaxel. J BUON. 2013;18(1):57–63.
Hammond ME, Hayes DF, Wolff AC, Mangu PB, Temin S. American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Oncol Pract. 2010;6(4):195–7. doi:10.1200/JOP.777003.
Cohen DA, Dabbs DJ, Cooper KL, Amin M, Jones TE, Jones MW, et al. Interobserver agreement among pathologists for semiquantitative hormone receptor scoring in breast carcinoma. Am J Clin Pathol. 2012;138(6):796–802. doi:10.1309/AJCP6DKRND5CKVDD.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med. 2010;134(7):e48–72. doi:10.1043/1543-2165-134.7.e48.
Avci N, Deligonul A, Tolunay S, Cubukcu E, Olmez OF, Ulas A, et al. Neoadjuvant chemotherapy-induced changes in immunohistochemical expression of estrogen receptor, progesterone receptor, HER2, and Ki-67 in patients with breast cancer. J BUON. 2015;20(1):45–9.
Neubauer H, Gall C, Vogel U, Hornung R, Wallwiener D, Solomayer E, et al. Changes in tumour biological markers during primary systemic chemotherapy (PST). Anticancer Res. 2008;28(3B):1797–804.
Lee SH, Chung MA, Quddus MR, Steinhoff MM, Cady B. The effect of neoadjuvant chemotherapy on estrogen and progesterone receptor expression and hormone receptor status in breast cancer. Am J Surg. 2003;186(4):348–50.
Taucher S, Rudas M, Gnant M, Thomanek K, Dubsky P, Roka S, et al. Sequential steroid hormone receptor measurements in primary breast cancer with and without intervening primary chemotherapy. Endocr Relat Cancer. 2003;10(1):91–8.
Zambetti M, Mansutti M, Gomez P, Lluch A, Dittrich C, Zamagni C, et al. Pathological complete response rates following different neoadjuvant chemotherapy regimens for operable breast cancer according to ER status, in two parallel, randomized phase II trials with an adaptive study design (ECTO II). Breast Cancer Res Treat. 2012;132(3):843–51. doi:10.1007/s10549-011-1660-6.
Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7. doi:10.1038/nature01322.
Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer. 2015;113(1):150–8. doi:10.1038/bjc.2015.183.
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(1):55–9. doi:10.4048/jbc.2013.16.1.55.
Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19(1):217–24. doi:10.1245/s10434-011-1814-0.
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. doi:10.2147/OTT.S69657.
Azab B, Shah N, Radbel J, Tan P, Bhatt V, Vonfrolio S, et al. Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients. Med Oncol. 2013;30(1):432. doi:10.1007/s12032-012-0432-4.
Suppan C, Bjelic-Radisic V, La Garde M, Groselj-Strele A, Eberhard K, Samonigg H, et al. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC Cancer. 2015;15:1027. doi:10.1186/s12885-015-2005-3.
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(4):1104–10. doi:10.1245/s10434-015-4934-0.
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. doi:10.1186/s12885-016-2352-8.
Eryilmaz MK, Mutlu H, Salim DK, Musri FY, Tural D, Coskun HS. The neutrophil to lymphocyte ratio has a high negative predictive value for pathologic complete response in locally advanced breast cancer patients receiving neoadjuvant chemotherapy. Asian Pac J Cancer Prev. 2014;15(18):7737–40.
Adachi K, Sakurai K, Suzuki S, Hara Y, Nagashima S, Hirano T, et al. Study of the response rate and neutrophil lymphocyte ratio in breast cancer patients undergoing neoadjuvant chemotherapy. Gan To Kagaku Ryoho. 2015;42(10):1283–5.
Acknowledgements
This work was supported by Grants from the National Natural Science Foundation of China (No. 81502615, No. 31470885, No. 31300752 and No. 31270971).
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This study was approved by hospital medical ethics committee of the Tai’an City Central Hospital and Qilu Hospital of Shandong University.
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12094_2017_1630_MOESM1_ESM.tif
Supplementary Fig. 1 Representative pictures of different degrees of ER expression (negative/-, +, ++and +++) by immunohistochemistry (×200). Upper panel, ER expression before NAC; lower panel, ER expression after NAC. (TIFF 12936 kb)
12094_2017_1630_MOESM2_ESM.tif
Supplementary Fig. 2 Representative pictures of different degrees of PR expression (negative/-, +, ++and +++) by immunohistochemistry (×200). Upper panel, PR expression before NAC; lower panel, PR expression after NAC. (TIFF 13099 kb)
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Xu, J., Ni, C., Ma, C. et al. Association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with ER and PR in breast cancer patients and their changes after neoadjuvant chemotherapy. Clin Transl Oncol 19, 989–996 (2017). https://doi.org/10.1007/s12094-017-1630-5
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DOI: https://doi.org/10.1007/s12094-017-1630-5