Low tumor-infiltrating lymphocytes (TIL) and high platelet lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and mean platelet volume (MPV) as a risk factor of metastasis in triple-negative breast cancer (TNBC)

Introduction: Triple Negative Breast Cancer (TNBC) is a subtype of breast cancer that is more aggressive and has a poor prognosis associated with an increased risk of metastasis. Cancer cells are known to trigger an inflammatory process which in turn causes tissue and vascular invasion, leading to changes in the levels of several hematological components. Unfortunately, research regarding various biomarkers in TNBC metastasis is still limited and argumentative. This study aims to determine the role of immune system-derived indices as biomarkers of metastasis in TNBC. Method: This is a case-control study to examine the relationship between tumor-infiltrating lymphocyte (TIL), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) on metastasis in patients with TNBC subtype breast cancer. This research took place at the Medical Records Installation at RSUP Prof. DR. I.G.N.G Ngoerah Denpasar from August 2021 - April 2022. Research subjects were breast cancer patients with TNBC subtypes with metastases and without metastases who were registered in the Surgical Oncology Division in 2016-2021. All data analysis used SPSS for Windows version 23.0 with the p-value considered significant if p<0.05. Results: A total of 100 research subjects were divided into metastatic (44 patients) and non-metastatic (56 patients) groups with a mean age of 52.97 +/- 12.67 and 51.98 +/- 10.86 years, respectively. Bivariate analysis showed a significant relationship between TIL (OR 0.163; IK95% 0.067 - 0.399; p=0.000), NLR (OR 3.644; IK95% 1.585 - 8.375; p=0.002), PLR (OR 9.755; IK95% 3.872 - 24.580; p=0.000), MPV (OR 9.500; 95% CI 6.512 - 58.393; p=0.000) on the incidence of metastasis. Multivariate analysis showed a significant relationship between the NLR and MPV variables (p<0.05). Conclusion: Patients with metastases had significantly higher NLR and MPV values and significantly increased risk of metastasis in TNBC.