Evidence map›Paper›PMID 28057046›Full record

SynthesisBreast cancer research : BCR2017

Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis.

Josee-Lyne Ethier, Danielle Desautels, Arnoud Templeton, Prakesh S Shah, Eitan Amir

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Breast cancer research : BCR, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 377 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
377citing papers in PubMed, 12 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

377 citing papers in PubMed, 12 syntheses or guidelines pooled it.

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  17. The immunology of human breast cancer.Nature reviews. Immunology · 2026
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317 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Josee-Lyne EthierDivision of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue 5-124, Toronto, ON, M5G 2M9, Canada.
Danielle DesautelsDivision of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Arnoud TempletonDepartment of Medical Oncology, St. Claraspital Basel and Faculty of Medicine, University of Basel, Basel, Switzerland.
Prakesh S ShahInstitute of Health Policy and Management Evaluation, University of Toronto, Toronto, Canada.
Eitan AmirDivision of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue 5-124, Toronto, ON, M5G 2M9, Canada. eitan.amir@uhn.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in several malignancies. Here, we quantify the effect of NLR on survival in patients with breast cancer, and examine the effect of clinicopathologic factors on its prognostic value.

methodsA systematic search of electronic databases was conducted to identify publications exploring the association of blood NLR (measured pre treatment) and overall survival (OS) and disease-free survival (DFS) among patients with breast cancer. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance. Meta-regression was performed to evaluate the influence of clinicopathologic factors such as age, disease stage, tumor grade, nodal involvement, receptor status, and NLR cutoff on the HR for OS and DFS. All statistical tests were two-sided.

resultsFifteen studies comprising a total of 8563 patients were included. The studies used different cutoff values to classify high NLR (range 1.9-5.0). The median cutoff value for high NLR used in these studies was 3.0 amongst 13 studies reporting a HR for OS, and 2.5 in 10 studies reporting DFS outcomes. NLR greater than the cutoff value was associated with worse OS (HR 2.56, 95% CI = 1.96-3.35; P < 0.001) and DFS (HR 1.74, 95% CI = 1.47-2.07; P < 0.001). This association was similar in studies including only early-stage disease and those comprising patients with both early-stage and metastatic disease. Estrogen receptor (ER) and HER-2 appeared to modify the effect of NLR on DFS, because NLR had greater prognostic value for DFS in ER-negative and HER2-negative breast cancer. No subgroup showed an influence on the association between NLR and OS.

conclusionsHigh NLR is associated with an adverse OS and DFS in patients with breast cancer with a greater effect on disease-specific outcome in ER and HER2-negative disease. NLR is an easily accessible prognostic marker, and its addition to established risk prediction models warrants further investigation.

Indexed as

Leukocyte CountLymphocyte CountLymphocytesNeutrophilsBreast NeoplasmsFemaleHumansPrognosisProportional Hazards ModelsPublication BiasBreast cancerDisease-free survivalMeta-analysisNeutrophil-to-lymphocyte ratioOverall survivalPrognosisSystematic review

Identifiers

PMID28057046
PMCPMC5217326

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.