Changes in the ratio of the absolute number of neutrophils, monocytes, platelets and lymphocytes in the peripheral blood are one of the markers of the activity of the systemic inflammatory response (SIR).

OBJECTIVE

To evaluate the prognostic significance of SIR hematological indicators in patients with breast cancer (BC), whose treatment tactics included surgery followed by adjuvant therapy.

MATERIAL AND METHODS

The study included 107 patients with luminal HER2-negative BC of stages I-III. Correlations between initial NLR, PLR, MLR, SII, SIRI indices, clinical and morphological risk factors and disease-free survival (DFS) of patients were assessed.

RESULTS

Medians of the hematological parameters in patients with relapse/progression of breast cancer and patients in remission were: NLR — 3.3 vs 2.2 (p=0.002), PLR — 226 vs 163 (p=0.003), MLR — 0.48 vs 0.25 (p<0.001), SII — 799 vs 572 (p=0.023), SIRI — 1.6 vs 0.84 (p<0.001), respectively. The best classification of disease relapse and remission cases according to ROC analysis is achieved using MLR (AUC=0.777) and SIRI (AUC=0.789). In univariate Cox regression analysis, the highest risk of disease recurrence with a high level of confidence was obtained for NLR³3.0 (HR=5.8 [2.1—15.6], p<0.001) and MLR³0.38 (HR=7.7 [2.8—21.8], p<0.001). In multivariate analysis, independent predictors of tumor relapse/progression were: NLR³3.0 (HR=6.3 [2.2—17.5], p=0.0005); age of patients 60 years and older (HR=5.0 [1.7—15.1], p=0.004); metastases in regional lymph nodes (cN+; HR=4.1 [1.6—10.8], p=0.004). The AUC for the model including age ≥60 years, cN+ and NLR≥3.0 was 0.880 (0.816—0.945), p<0.0001.

CONCLUSION

Initially elevated NLR, MLR and/or SIRI in patients with hormone-dependent HER2-negative BC receiving adjuvant therapy are associated with recurrence of the disease after treatment, which is advisable to take into account as an additional prognostic factor when choosing treatment tactics in this group of patients.