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The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis

Authors Wei B, Yao M, Xing C, Wang W, Yao J, Hong Y, Liu Y, Fu P

Received 14 March 2016

Accepted for publication 14 June 2016

Published 8 September 2016 Volume 2016:9 Pages 5567—5575


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Chang Liu

Peer reviewer comments 4

Editor who approved publication: Professor Min Li

Bajin Wei,1,2 Minya Yao,1 Chunyang Xing,2 Wei Wang,2 Jia Yao,1 Yun Hong,1 Yu Liu,1 Peifen Fu1,2

1Diagnosis and Treatment of Breast Diseases Center, 2Key Laboratory of Organ Transplantation, Key Laboratory of Combined Multi-Organ Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China

Abstract: Breast cancer (BC) is the most common female malignancy within the spectrum of human cancer. One promising way to reduce the mortality and morbidity of BC is to explore novel diagnostic markers for early diagnosis and prognostication. The neutrophil lymphocyte ratio (NLR) is a good reflection of inflammation, which plays an important role in tumor progression and metastasis. However, the association between NLR and BC prognosis remains unclear. The aim of this meta-analysis is to explore the prognostic value of NLR in BC. Among the screened references in the database, 12 eligible studies were identified in this study. Patients with a higher NLR had a shorter disease-free survival (hazard ratio =1.46, 95% confidence interval: 1.12–1.90, P=0.044) and overall survival (hazard ratio =2.03, 95% confidence interval: 1.41–2.93, P<0.001). In the subgroup analysis of NLR and disease-free survival, the studies from Eastern countries had a positive result with perfect homogeneity (I2=0); however, this homogeneity has not been achieved in studies from Western countries. In the subgroup analysis of the NLR and overall survival, the results of the univariate and multivariate analyses were completely different, with different heterogeneity. In the luminal A and luminal B subtypes, we found that there was no association between the NLR and overall survival in the BC patients. Positive results were obtained in the analyses of the human epidermal growth factor receptor 2 (HER2)-positive and triple-negative BC subtypes. In conclusion, this meta-analysis suggests that NLR is a good prognostic marker for BC, and patients with a higher NLR have poorer prognoses. Future studies should perform more detailed investigations to decrease heterogeneity and determine the appropriate cut-off values for different races.

Keywords: disease-free survival, overall survival, inflammatory factor, lymphocytosis, lymphocytopenia, neutrophilic leukocytosis, neutrophilicgranulocytopenia, prognosis

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