Prognostic Value of Neutrophil-Lymphocyte Ratio Change After Short-Term Chemotherapy in <i>De Novo</i> Stage IV Breast Cancer Patients

We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) change after the first cycle of palliative chemotherapy can be a prognostic indicator in <i>de novo</i> stage IV breast cancer. We retrospectively reviewed 218 patients treated between January 1997 and December 2012 at Asan Medical Center, Seoul, Korea. The NLR change (ΔNLR = NLR after first cycle of chemo - initial NLR [iNLR]) was significantly inversely associated with breast cancer specific survival (BCSS) (<i>p</i> = 0.031). The 1-, 3-, and 5-year BCSS rates of patients in the increased NLR group were 78.4%, 37.8%, and 25.7%, and 88.9%, 55.6%, and 35.4%, respectively, in the other group (<i>p</i> = 0.035, 0.014, and 0.043, respectively). Multivariate analysis suggested that NLR was an independent prognostic factor (hazard ratio [HR], 1.748; 95% confidence interval [CI], 1.084-2.818). When patients were divided into four groups combining iNLR and ΔNLR, patients in high iNLR & increased NLR group (HR, 4.294; 95% CI, 1.586-11.629) had worst prognosis compared to patients in low iNLR & stationary or decreased NLR groups.