Association of anemia and neutrophil-lymphocyte ratio with overall survival in breast cancer patients

Objective: The neutrophil-lymphocyte ratio (NLR) has been shown to correlate with disease progression and survival in a number of cancers. In this study we explore this ratio and a number of other blood-derived factors, including platelet-lymphocyte ratio (PLR) and hemoglobin levels, for their prognostic value with overall survival in breast cancer patients. Methods: A retrospective study was conducted with data from the medical records of patients with breast cancer (n = 303) collected from a breast cancer treatment and research clinic. The data included clinical staging at diagnosis, tumor size, axillary lymph node involvement, presence or absence of metastases, tumor histology, tumor grade, hormone receptor, treatments received (surgery, chemotherapy, hormonotherapy), overall survival, NLR, PLR, anemia, leukocytosis, neutrophilia, and lymphopenia. Cox regression was used to verify the influence of the variables on five-year overall survival of patients following their initial diagnosis. Results: Patients with NLR >4 showed association with staging >II (p < 0.05), with the presence of metastasis (p < 0.0001), and with negative hormone receptor (p < 0.0001). A hemoglobin <12 g/dL associated with staging >II (p < 0.0001), with the presence of metastasis (p < 0.0001), and with negative hormone receptor (p < 0.05). High values of NLR and PLR were associated with shorter overall survival by Kaplan-Meier survival curves (p < 0.001 and p = 0.021, respectively). After multivariate regression, tumor size, lymph node status, metastasis, NLR and anemia remained as factors that independently influenced mortality at 5 years. NLR >4 increased the risk of death by 7.76 times (p < 0.001) and hemoglobin <12 mg/d increased the risk of death by 2.47 times (p = 0.037). Conclusions: NLR and anemia are factors that independently correlate with overall survival in breast cancer patients. These factors have the advantage of being derived from simple and inexpensive blood testing.