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Authors Hong J, Chen X, Gao W, Zhu S, Wu J, Huang O, He J, Zhu L, Chen W, Li Y, Fei X, Lin L, Shen K
Received 12 September 2018
Accepted for publication 7 March 2019
Published 18 April 2019 Volume 2019:11 Pages 3371—3379
DOI https://doi.org/10.2147/CMAR.S187233
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Rituraj Purohit
Background: Immune
responses play an important role in the development of breast cancer.
Trastuzumab can activate antibody-dependent cellular cytotoxicity (ADCC) in
human epidermal growth factor receptor-2 (HER-2)-positive breast cancer. Many
studies have demonstrated that inflammatory markers, such as the
neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC), are
associated with prognosis in breast cancer. The aim of this study was to
explore whether preoperative NLR, ALC or the absolute neutrophil count (ANC) is
associated with prognosis in HER-2-positive breast cancer patients who received
adjuvant trastuzumab.
Patients and methods: Three
hundred sixty-seven female patients with HER-2-positive invasive breast cancer
who were treated with one-year adjuvant trastuzumab were analysed in this
retrospective study. Preoperative haematological parameters,
clinicopathological data and survival data were obtained. The cut-off points
for ALC, ANC and NLR were based on the median values. Disease-free survival
(DFS) and Overall survival (OS) were analysed by the Kaplan-Meier method.
Multivariable Cox regression was used to determine the independent prognostic
significance of ALC, ANC and NLR.
Results: Survival
analysis revealed that the 3-year DFS in patients with high ALC was 89.0%,
which was significantly worse than 95.0% in patients with low ALC (p =0.014).
Kaplan-Meier analysis also showed that patients with low NLR had a poorer
3-year DFS than patients with high NLR (89.7% vs 94.0%, respectively; p =0.047).
Multivariate analysis showed that ALC was an independent prognostic factor for
DFS (HR=2.723; 95% CI=1.211–6.122; p =0.015). Neither ANC, ALC nor NLR could predict OS
independently.
Conclusion: In
HER-2-positive breast cancer patients who were treated with adjuvant
trastuzumab, a high ALC is significantly associated with a poor DFS.
Keywords: breast
cancer, HER-2 positive, trastuzumab, absolute lymphocyte count,
neutrophil-to-lymphocyte ratio