Anthracyclines (doxorubicin, epirubicin) are breast cancer patients treated with the neutrophil / lymphocyte levels of prognostic effect

Aim:The aim of this study was to evaluate breast cancer patients treated with anthracycline chemotherapy to provide evidence about the predictive and prognostic value of NLR in response to chemotherapy. Method:Pre-chemotherapy blood tests and pathology results of 150 patients admitted to Zonguldak Bülent Ecevit University, Medical Faculty, Health Application and Research Center, Medical Oncology Department outpatient clinic between2013-2019 were retrospectively evaluated.150 patients who met the inclusion criteria were included in the study.Neutrophil/lymphocyte ratio (NLR), age, body mass index, ca 15-3 level, Her2 and ki-67 status, hormone receptor status, histopathological type and menopause status were recorded before chemotherapy treatment.Statistical analysis was performed using SPSS 19.0 program. The normal distribution of numerical variables was examined by Shapiro-Wilk test. Descriptive statistics for numerical variables were expressed as arithmetic mean ± standard deviation and median (minimum-maximum) and numbers and percentages for categorical data.Differences between the groups in terms of categorical variables were examined by Chi-square test. When parametric test assumptions were provided, the significance test of the difference between the two means was used for comparison of the mean of the two groups, and Kruskal Wallis Analysis of Variance was used. p <0.05 was considered significant. Results:All 150 patients were female. The neutrophil / lymphocyte ratio (NLR) of the breast cancer patients included in the study was 0.75 at lowest and 17.6 at highest. The mean neutrophil/lymphocyte ratio was 2.3 ± 1.6. The mean neutrophil value was determined as 4.7 ± 1.5 x 103 / µL. The lowest and highest neutrophil values were 2.1 x 103 / µL and 8.6 x 103 / µL, respectively.The mean lymphocyte value was 2.3 ± 0.8 x 103 / µL. The lowest and highest lymphocyte values were 0.3 x 103 / µL and 5.9 x 103 / µL, respectively.When the response rates of our patients after chemotherapy were examined, 81.3% (n = 122) patients had regression, 13.3% (n = 20) patients had stable disease and 5.3% (n = 8) patients had progression. The mean neutrophil/lymphocyte ratio was 2.38 ± 1.76, the neutrophil value was 4.6 ± 1.44 x 103 / µL, and the lymphocyte value was 2.25 ± 0.8 x 103 / µL. The mean neutrophil/lymphocyte ratio of patients with stable disease was 1.99 ± 0.71, the mean neutrophil value was 4.81 ± 1.69 x 103 / µL, the mean lymphocyte value was 2.47 ± 0.57 x 103 / µL, The mean neutrophil / lymphocyte ratio was 2.3 ± 0.72, the mean neutrophil value was 5.36 ± 1.8 x 103 / µL and the mean lymphocyte value was 2.45 ± 0.99 x 103 / µL. When chemotherapy response rates (regression, stable disease or progression) were compared, no significant difference was found between neutrophil, lymphocyte, neutrophil-lymphocyte ratio averages (p = 0.496, p = 0.269, p = 0.631). In 58.2% (n = 71) of patients with regression after chemotherapy, NLO was below 2.3, in 41.8% (n = 51) of patients with NLO 2.3 and above, 70% of patients with stable disease (n = 14) NLO below 2.3, 30% (n = 6) NLO 2.3 and above, 50% (n = 4) of patients with progression below NLO 2.3, 50% (n = 4) NLO was found to be 2.3 and above. There was no significant difference between the response rates of patients after chemotherapy and NLR (p = 0.523). Conclusion:No significant difference was found between NLR and prognosis in our study. Our study has limitations such as it is retrospective, single centered and it has an insufficient number of patients. We believe that NLR may be used as an important marker in the future with studies with a larger number of patients. More comprehensive studies will be helpful in elucidating the neutrophil/lymphocyte ratio before treatment in breast cancer patients. Keywords: Anthracycline, Neutrophil/Lymphocyte ratio, Breast cancer