Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis

• Published in: Breast cancer research : BCR 2017-01, Vol.19 (1), p.2-2, Article 2
• Main Authors: Ethier, Josee-Lyne, Desautels, Danielle, Templeton, Arnoud, Shah, Prakesh S, Amir, Eitan
• Format: Article
• Language: English
• Subjects: Breast Neoplasms - blood; Breast Neoplasms - mortality; Female; Humans; Leukocyte Count; Lymphocyte Count; Lymphocytes; Neutrophils; Prognosis; Proportional Hazards Models; Publication Bias
• ISSN: 1465-542X; 1465-5411; 1465-542X
• DOI: 10.1186/s13058-016-0794-1

The presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in several malignancies. Here, we quantify the effect of NLR on survival in patients with breast cancer, and examine the effect of clinicopathologic factors on its prognostic value. A systematic search of electronic databases was conducted to identify publications exploring the association of blood NLR (measured pre treatment) and overall survival (OS) and disease-free survival (DFS) among patients with breast cancer. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance. Meta-regression was performed to evaluate the influence of clinicopathologic factors such as age, disease stage, tumor grade, nodal involvement, receptor status, and NLR cutoff on the HR for OS and DFS. All statistical tests were two-sided. Fifteen studies comprising a total of 8563 patients were included. The studies used different cutoff values to classify high NLR (range 1.9-5.0). The median cutoff value for high NLR used in these studies was 3.0 amongst 13 studies reporting a HR for OS, and 2.5 in 10 studies reporting DFS outcomes. NLR greater than the cutoff value was associated with worse OS (HR 2.56, 95% CI = 1.96-3.35; P