Prognostic value of systemic inflammatory markers and development of a nomogram in breast cancer

被引:110
作者
Cho, Uiju [1 ]
Park, Hong Sik [1 ]
Im, So Young [1 ]
Yoo, Chang Young [1 ]
Jung, Ji Han [1 ]
Suh, Young Jin [2 ]
Choi, Hyun Joo [1 ]
机构
[1] Catholic Univ Korea, Coll Med, St Vincents Hosp, Dept Hosp Pathol, Seoul, South Korea
[2] Catholic Univ Korea, St Vincents Hosp, Coll Med, Dept Surg, Seoul, South Korea
关键词
PLATELET-LYMPHOCYTE RATIO; PRETREATMENT NEUTROPHIL; BLADDER-CANCER; POOR-PROGNOSIS; SURVIVAL; CARCINOMA; OUTCOMES; LYMPHOPENIA; PREDICTORS; MECHANISMS;
D O I
10.1371/journal.pone.0200936
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Systemic inflammatory markers derived from peripheral blood cell, such as the neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), have been demonstrated as prognostic markers in several types of malignancy. Here, we investigated and compared the association between systemic inflammatory markers and survival and developed a prognostic nomogram in breast cancer patients. We reviewed the clinical and pathological records of 661 patients diagnosed with invasive breast carcinoma between 1993 and 2011. The NLR, dNLR, PLR and LMR in the immediate preoperative period were assessed. We analyzed the relationship between these inflammatory markers and clinicopathologic variables, disease-specific survival (DSS), and disease-free survival (DFS) in patients. A nomogram was developed to predict 3-and 5-year DSS for breast cancer. In the univariate analysis, high NLR, dNLR, PLR and low LMR were all significantly associated with poor DSS and DFS. In the multivariate analysis, only the PLR (HR 3.226, 95% CI 1.768-5.885 for DSS and HR 1.824, 95% CI 1.824-6.321 for DFS) was still identified as an independent predictor of outcomes. A subgroup analysis revealed that the PLR was the sole independent marker predicting poor DSS in patients with lymph node metastasis (HR 2.294, 95% CI 1.102-4.777) and with luminal subtype (HR 4.039, 95% CI 1.905-8.562). The proposed nomogram, which includes the PLR, shows good accuracy in predicting DSS with a concordance index of 0.82. PLR is an indicator of systemic inflammation as a part of the host immune response. As an independent prognostic factor, an elevated preoperative PLR is superior to the NLR, dNLR, and LMR in predicting clinical outcomes in patients with breast cancer. Moreover, the nomogram incorporating the PLR could accurately predict individualized survival probability in breast cancer.
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页数:20
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