Neutrophil-to-lymphocyte ratio as a predictor of early death in metastatic triple-negative breast cancer

Background The prediction of survival using the neutrophil-to-lymphocytes ratio (NLR) in metastatic breast cancer is still under debate. We aimed to determine the mortality prognostic value of the NLR in female patients with metastatic triple-negative breast cancer. Methods. We reviewed 118 medical records of patients diagnosed and treated in a tertiary-care center over a 14-year period. The cut-off value for the NLR (<2.5 and ≥2.5) was determined with receiver operating characteristic curves (area under the curve: 0.73; 95% CI: 0.615, 0.851). Survival curves were estimated using the Kaplan-Meier method and compared with the Log-rank test. Multivariate Cox regression was used to identify the risk of mortality at two years. We further performed sensitivity analyses with different cut-off values and subgroup analysis in patients that only received chemotherapy. Results. The median follow-up was 24 months. Patients with an NLR ≥2.5 had a worse overall survival compared to patients with a NLR <2.5 (6% vs. 28%, p<0.001) at two years. This outcome remained consistent when we stratified for patients that received chemotherapy (8% vs. 36%, p=0.001). Multivariate analysis identified the NLR (≥2.5 vs. <2.5) at diagnosis as a prognostic risk factor for mortality in the entire population (HR: 2.12, 95% CI: 1.32-3.39) and in patients that received chemotherapy (HR: 2.68, 95% CI: 1.46 – 4.92). Conclusions. The NLR is an accessible biomarker that predicts early mortality in patients with metastatic triple-negative breast cancer. Physicians can use these results to predict survival in these patients.