The Effect of C-Reactive Protein/Lymphocyte Ratio (CLR) on PFS in Metastatic Breast Cancer Patients Treated with CDK4/6 Inhibitors: A Novel Biomarker

Figures & data

Table 1 Sociodemographic and Clinical Data (n = 78)

Variables	N	%
Age
Mean±SD	50.53±12.64
≤55	54	69.2
55>	24	30.8
Sex
Female	77	98.7
Male	1	1.3
Comorbidity
None	52	66.7
Yes	26	33.3
Smoking
Yes	63	81.8
No	14	18.2
Grade
≤2	45	57.7
2>	14	17.9
Ki67
≤20	29	52.7
>20	35	47.3
Metastasis site
Bone	47	60.3
Liver	1	1.3
Lung	5	6.4
Multiple	25	32.1
Which line
1st line	18	23.1
Prior Hormone Therapy	40	51.3
Adjuvant	23	29.5
Metastatic	17	21.8
Prior Chemotherapy	20	25.6
ER%
11–50	9	11.5
50>	69	88.5
Progression
No	21	26.9
Yes	57	73.1
Mortality
Alive	49	62.8
Ex	29	37.2
Average follow-up time	62.37±43.35

Table 2 Analysis of the Predictive Values of Various Parameter Values in Differentiating Mortality

Variables	AUC	%95 CI	Cut-off	Sensitivity (%)	Specificity (%)	p
NLR	0.729	0.564–0.894	≥2.54	61.5	60.0	0.022
SII	0.652	0.473–0.832	≥754.25	53.8	56.0	0.128
PNI	0.654	0.481–0.827	≤41.00	57.1	57.7	0.112
CRP/Lymphocyte (CLR)	0.742	0.557–0.926	≥6.04	76.9	72.0	0.016

Note: P<0.05 is bolded to indicate statistical significance.

Abbreviations: AUC, Area under the curve; %95CI, Confidence interval; NLR; neutrophil/lymphocyte ratio; SII, systemic inflammatory index; PNI, prognostic nutritional index; CRP, c-reactive protein; CLR, CRP/lymphocyte ratio.

Table 3 OS Comparisons of Patients

OS (Months)	2 Years %	5 Years %	Median (%95 CI)	p
OS	94.7	72.6	109.86 (68.34–151.38)
Age
≤55	98.1	82.0	121.63 (95.89–147.37)	0.008
55>	86.8	44.8	53.16 (24.34–81.98)
Comorbidity
No	98.1	79.2	109.86 (84.45–135.28)	0.171
Yes	88.3	60.2	78.13 (36.59–119.67)
ER%
11–50	88.9	77.8	71.93 (59.98–83.87)	0.245
50>	95.7	69.2	109.86 (77.71–142.01)
Grade
≤2	95.6	69.0	102.13 (39.60–164.66)	0.769
2>	92.9	77.1	78.13 (52.95–103.31)
Ki67
≤20	94.9	80.1	102.13 (42.02–162.24)	0.339
20>	94.1	65.5	92.73 (63.09–122.37)
NLR
<2.54	94.6	75.4	121.63 (53.46–189.80)	0.448
≥2.54	94.4	67.1	92.73 (61.04–124.42)
CRP/ lymphocyte (CLR)
<6.04	100.0	77.8	– (–)	0.006
≥6.04	88.5	48.0	54.33 (15.07–93.59)

Note: P<0.05 is bolded to indicate statistical significance.

Abbreviations: OS, overall survival; ER, estrogen receptor; NLR, neutrophil/lymphocyte ratio; CRP, c-reactive protein; CLR, CRP/lymphocyte ratio.

Table 4 Person-Year Mortality Rates

Months	n Patients	Survival %
0	78	100
12	76	96
24	66	92
36	55	84
48	39	77
60	32	70
72	25	61
84	20	58
96	13	54
108	11	46
120	9	41
132	5	29
144	2	29
156	2	29
168	2	29
180	2	29
192	1	29
204	1	29
216	1	29
228	1	29
240	1	29

Table 5 PFS Comparisons of Patients

PFS (Months)	2 Years %	5 Years %	Median (% 95 CI)	p
PFS	30.4	–	14.86 (11.66–18.06)
Age
≤55	26.1	–	14.50 (11.75–17.24)	0.286
55>	40.4	–	15.60 (9.38–21.81)
Comorbidity
No	98.1	79.2	54.00 (39.69–68.30)	0.299
Yes	88.3	60.2	76.63 (34.40–118.86)
ER%
11–50	33.3	–	13.70 (0.00–38.82)	0.770
50>	29.6	–	15.23 (11.42–19.04)
Grade
≤2	42.0	–	16.00 (8.61–23.90)	0.370
2>	12.5	–	14.50 (3.33–25.67)
Ki67
≤20	48.7	–	23.63 (10.85–36.41)	0.021
20>	13.9	–	12.20 (7.79–16.60)
NLR
<2.54	35.8	–	17.26 (7.89–26.63)	0.701
≥2.54	25.6	–	14.86 (12.80–16.93)
CRP/ lymphocyte (CLR)
<6.04	31.6	–	29.70 (16.88–24.51)	0.022
≥6.04	20.0	–	8.40 (0.02–16.78)

Note: P<0.05 is bolded to indicate statistical significance.

Abbreviations: PFS, progression free survival; ER, estrogen receptor; NLR, neutrophil/lymphocyte ratio; CRP, c-reactive protein; CLR, CRP/lymphocyte ratio.

Figure 1 PFS time treatment with CDK4/6i (A), Ki67 ve PFS time (B), CLR ve PFS time (C).

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.