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      A high neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are associated with a worse outcome in inflammatory breast cancer

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          Abstract

          Introduction

          Inflammatory breast cancer (IBC) is an uncommon, but aggressive form of breast cancer that accounts for a disproportionally high fraction of breast cancer related mortality. The aim of this study was to explore the peripheral immune response and the prognostic value of blood-based biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), in a large IBC cohort.

          Patients & methods

          We retrospectively identified 127 IBC patients and collected lab results from in-hospital medical records. The differential count of leukocytes was determined at the moment of diagnosis, before any therapeutic intervention. A cohort of early stage (n = 108), locally advanced (n = 74) and metastatic breast cancer patients (n = 41) served as a control population.

          Results

          The NLR was significantly higher in IBC compared to an early stage breast cancer cohort, but no difference between IBC patients and locally advanced breast cancer patients was noted. In the metastatic setting, there was also no significant difference between IBC and nIBC. However, a high NLR (>4.0) remained a significant predictor of worse outcome in IBC patients (HR: 0.49; 95% CI: 0.24–1.00; P = .05) and a lower platelet-lymphocyte ratio (PLR) (≤210) correlated with a better disease-free survival (DFS) (HR: 0.51; 95% CI: 0.28–0.93; P = .03).

          Conclusion

          Patients with a high NLR (>4.0) have a worse overall prognosis in IBC, while the PLR correlated with relapse free survival (RFS). Since NLR and PLR were not specifically associated with IBC disease, they can be seen as markers of more extensive disease.

          Highlights

          • •

            There is no association between NLR or PLR and inflammatory breast cancer (IBC).

          • •

            IBC and non-inflammatory breast cancer elicit a similar peripheral immune response.

          • •

            A high neutrophil-to-lymphocyte ratio (NLR) is associated with a worse overall survival in IBC.

          • •

            A high platelet-lymphocyte ratio (PLR) correlates with a worse disease-free survival in IBC.

          • •

            An elevated PLR or NLR should be seen as a marker of more extensive disease in IBC.

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          Most cited references30

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          Role of platelets and platelet receptors in cancer metastasis

          Martin Schlesinger (2018)
          The interaction of tumor cells with platelets is a prerequisite for successful hematogenous metastatic dissemination. Upon tumor cell arrival in the blood, tumor cells immediately activate platelets to form a permissive microenvironment. Platelets protect tumor cells from shear forces and assault of NK cells, recruit myeloid cells by secretion of chemokines, and mediate an arrest of the tumor cell platelet embolus at the vascular wall. Subsequently, platelet-derived growth factors confer a mesenchymal-like phenotype to tumor cells and open the capillary endothelium to expedite extravasation in distant organs. Finally, platelet-secreted growth factors stimulate tumor cell proliferation to micrometastatic foci. This review provides a synopsis on the current literature on platelet-mediated effects in cancer metastasis and particularly focuses on platelet adhesion receptors and their role in metastasis. Immunoreceptor tyrosine-based activation motif (ITAM) and hemi ITAM (hemITAM) comprising receptors, especially, glycoprotein VI (GPVI), FcγRIIa, and C-type lectin-like-2 receptor (CLEC-2) are turned in the spotlight since several new mechanisms and contributions to metastasis have been attributed to this family of platelet receptors in the last years.
          Article 0 comments Cited 250 times – based on 0 reviews     Review now
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            International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment.

            S. Dawood, S.D. Merajver, P Viens … (2011)
            Inflammatory breast cancer (IBC) represents the most aggressive presentation of breast cancer. Women diagnosed with IBC typically have a poorer prognosis compared with those diagnosed with non-IBC tumors. Recommendations and guidelines published to date on the diagnosis, management, and follow-up of women with breast cancer have focused primarily on non-IBC tumors. Establishing a minimum standard for clinical diagnosis and treatment of IBC is needed. Recognizing IBC to be a distinct entity, a group of international experts met in December 2008 at the First International Conference on Inflammatory Breast Cancer to develop guidelines for the management of IBC. The panel of leading IBC experts formed a consensus on the minimum requirements to accurately diagnose IBC, supported by pathological confirmation. In addition, the panel emphasized a multimodality approach of systemic chemotherapy, surgery, and radiation therapy. The goal of these guidelines, based on an expert consensus after careful review of published data, is to help the clinical diagnosis of this rare disease and to standardize management of IBC among treating physicians in both the academic and community settings.
            Article 0 comments Cited 133 times – based on 0 reviews     Review now
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              Usefulness of Pretreatment Neutrophil to Lymphocyte Ratio in Predicting Disease-Specific Survival in Breast Cancer Patients

              Hany Noh, Minseob Eomm, Airi Han (2013)
              Purpose The purpose of this study was to investigate the prognostic impact of pretreatment neutrophil to lymphocyte ratio (NLR) on breast cancer in view of disease-specific survival and the intrinsic subtype. Methods We retrospectively studied patients diagnosed with primary breast cancer that had completed all phases of primary treatment from 2000 to 2010. The association between pretreatment NLR and disease-specific survival was analyzed. Results A total of 442 patients were eligible for analysis. Patients with higher NLR (2.5 ≤NLR) showed significantly lower disease-specific survival rate than those with lower NLR (NLR <2.5). Higher NLR along with negative estrogen receptor status and positive nodal status were independently correlated with poor prognosis, with hazard ratio 4.08 (95% confidence interval [CI], 1.62-10.28), 9.93 (95% CI, 3.51-28.13), and 11.23 (95% CI, 3.34-37.83), respectively. Luminal A subtype was the only intrinsic subtype in which higher NLR patients showed significantly poor prognosis (87.7% vs. 96.7%, p=0.009). Conclusion Patients with an elevated pretreatment NLR showed poorer disease-specific survival than patients without elevated NLR, most evident in the luminal A subtype. Further validation and a feasibility study are required before it can be considered for clinical use.
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                Author and article information

                Contributors
                C. Van Berckelaer
                Journal
                Journal ID (nlm-ta): Breast
                Journal ID (iso-abbrev): Breast
                Title: The Breast : Official Journal of the European Society of Mastology
                Publisher: Elsevier
                ISSN (Print): 0960-9776
                ISSN (Electronic): 1532-3080
                Publication date PMC-release: 17 August 2020
                Publication date Collection: October 2020
                Publication date (Electronic): 17 August 2020
                Volume: 53
                Pages: 212-220
                Affiliations
                [a ]Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium
                [b ]Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
                [c ]Department of Oncology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
                [d ]Department of Pathology, UZA, Antwerp University Hospital, Edegem, Belgium
                Author notes
                [∗ ]Corresponding author. Translational Cancer Research Unit, CORE, University of Antwerp Oosterveldlaan 24 2610, Antwerp, Belgium. Christophe.vanberckelaer@ 123456uantwerpen.be
                [1]

                Both authors contributed equally.

                Article
                Publisher ID: S0960-9776(20)30159-4
                DOI: 10.1016/j.breast.2020.08.006
                PMC ID: 7481565
                PubMed ID: 32890963
                SO-VID: 88d438bb-abfd-43ef-87c0-0da37f73362a
                Copyright © © 2020 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 17 March 2020
                Date revision received : 5 July 2020
                Date accepted : 10 August 2020
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: inflammatory breast cancer (ibc),neutrophil-to-lymphocyte ratio (nlr),platelet-lymphocyte ratio (plr),lymphocyte-monocyte ratio (lmr),stromal tumor infiltrating lymphocytes (stil),immune response
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: inflammatory breast cancer (ibc), neutrophil-to-lymphocyte ratio (nlr), platelet-lymphocyte ratio (plr), lymphocyte-monocyte ratio (lmr), stromal tumor infiltrating lymphocytes (stil), immune response

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