Impact of Neutrophil-lymphocyte ratio and Albumin-Globulin ratio on the outcome of  women with metastatic breast cancer.

Shereen Elshorbagy; Assistant professor of medical oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt., Rana Ebied; Resident of medical oncology, Al Ahrar Teaching hospital, Zagazig/ Egypt, Ola Elfarargy; Assistant professor of medical oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

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Introduction: Breast cancer is the most frequent malignancy among women all over the globe. The cancer related inflammation-based markers in Peripheral blood such as neutrophil-lymphocyte ratio (NLR) and albumin/globulin ratio (AGR) is a simple and cost-effective measure that correlates with cancer patient prognosis and treatment response.

Aim: This study aims to determine progression free survival (PFS) and overall survival (OS) of (NLR) and (AGR) in women with metastatic breast cancer(MBC) considering other clinical variables.

Patients and methods: This study retrospectively analyzed sixty female patients diagnosed with MBC either de novo or post early presentation treatment, whose were treated according to their primary physician plan with hormonal therapy, chemotherapy and or targeted therapy in medical oncology department Zagazig university from January 2015 to December 2017. Inclusion criteria were female patients diagnosed with MBC aged ≥ 18 years with available full data are included. Patients suffering from malignancy other than Breast Cancer (BC), male BC patients or cases with incomplete data were excluded from the study then was analyzed by Kaplan -Meier and cox regression methods.

Results: Kaplan-Meier method and Survival curves were found negative significant difference between NLR level with cutoff (>1.9) and OS of patients(p=<0.001). Univariate analysis showed positive significant difference between AGR with cut-off value (≤ 1.1) and (OS);( p=<0.001), with inverse statistical correlation between NLR and AGR. On the other side, there were neither statistically significant differences between NLR nor AGR and PFS with p-value (0.987, 0.297) respectively. Cox regression analysis was performed to ascertain that no statistically significant differences between clinicopathologic criteria of our studied patients with OS and PFS.

Conclusion: Our study suggested that NLR and AGR are significant prognostic biomarkers for (OS) in patients with MBC, low AGR/ high NLR are related to poor overall survival with no association with other parameters. An indirect inverse significant correlation was noticed between NLR and AGR., Cancer is different in each patient and personalized treatment should be a priority.