Association Between Neutrophil-Lymphocyte Ratio and Oncotype Dx Recurrence Score in Early-Stage Hormonal Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer

Figures & data

Table 1 Patients Demographics and Disease Characteristics (n = 160)

Characteristics	Frequency (%)
Menopausal
Pre	99 (61.9)
Post	61 (38.1)
Tumor Grade
1	22 (13.8)
2	109 (68.1)
3	29 (18.1)
ER
Positive	159 (99.4)
Negative	1 (0.6)
PR
Positive	151 (94.4)
Negative	9 (5.6)
LVI
Positive	38 (23.8)
Negative	120 (75)
Missing	2
T stage
1	84 (52.5)
2	72 (45)
3	4
Ki-67
(≤20)	95 (59.4)
(>20)	62 (38.8)
Missing Oncotype Dx	3
<16	62 (38.8)
≥16	98 (61.3)
≥26	34 (21.3)
<26	126 (78.8)
BMI
≥30	81 (50.9)
<30	78 (49)
Missing	1
Comorbidities^a
Present	44 (27)
Absent	116 (72.5)

Notes: ^aComorbidities not under exclusion criteria: diabetes mellitus, hypertension, dyslipidemia, depression, hypothyroidism, and obesity.

Abbreviations: BMI, body mass index; ER, estrogen receptor; LVI, lymphovascular invasion; PR progesterone receptor.

Table 2 Patients and Disease Characteristics Stratified Based on Low and High NLR

Characteristics	High NLR ≥2.15 (n = 40)	Low NLR <2.15 (n = 120)
	n (%)	n (%)
Median age (IQR)	48.5 (42–56.5)	49 (42–56)
Pre-menopausal	24 (60)	75 (62.5)
Tumor Grade
1	7 (17.5)	15 (12.5)
2	22 (55)	87 (72.5)
3	11 (27.5)	18 (15)
ER-positive	40 (100)	119 (99.2)
PR-positive	36 (90)	115 (95.8)
LVI-positive	9 (22.5)	29 (24.6)
T stage
1	21 (52)	63 (52.5)
2	18 (45)	54 (45)
3	1 (2.5)	3 (2.5)
Ki-67 level
≤20	24 (60)	71 (59.2)
>20	16 (40)	46 (38.3)
Oncotype Dx
<16 (62/160)	9 (22.5)	53 (44.2)
≥16 (98/160)	31 (77.5)	67 (55.8)
≥26 (34/160)	15 (37.5)	19 (15.8)
<26 (126/160)	25 (62.5)	101 (84.2)
BMI ≥ 30 kg/m^2	62 (52.1)	19 (47.5)
BMI < 30 kg/m^2	57 (47.9)	21 (52.5)
Presence of Comorbidities	12 (30)	32 (26.7)

Abbreviations: ER, estrogen receptor; IQR, interquartile range; LVI, lymphovascular invasion; NLR, neutrophil-to-lymphocyte ratio; PR progesterone receptor.

Table 3 Multivariate Logistic Regression Analysis for ODX RS Cutoffs

	Oncotype Dx ≥ 26			Oncotype Dx < 16
	OR	95% CI	p-value	OR	95% CI	p-value
Menopausal status
Pre-menopausal	1			1
Post-menopausal	1.25	0.49–3.13	0.63	1.4	0.69–2.86	0.34
NLR
<2.15	1			1
≥2.15	5.4	1.2–8.05	0.01	0.39	0.16–0.92	0.03
Tumor Grade
G1/G2	1			1
G3	5.12	1.89–15.38	<0.01	0.25	0.06–0.95	0.04
Ki-67 level
≤20	1			1
>20	1.86	0.03–6.5	0.57	0.43	0.19–0.95	0.03

Abbreviations: CI, confidence interval; NLR, neutrophil-to-lymphocyte ratio; ODX RS, Oncotype DX recurrence score; OR, odds ratio.

Figure 1 Flow diagram for selection criteria.

Figure 2 ROC curve showed that neutrophil-to-lymphocyte ratio associated with Oncotype Dx and the cutoff point of 2.15 revealed 0.81 and 0.60 sensitivity and specificity, respectively.

Figure 3 Illustration showing the patients’ Oncotype Dx (ODX RS) recurrence score distribution <26 (green) vs ≥26 (blue) in the following four groups: low neutrophil-to-lymphocyte ratio (NLR; < 2.15) and low grade (G1/2), low NLR and high grade (G3), high NLR (≥2.15), and low grade, and high NLR and high grade (A). Illustration showing the patients’ ODX RS <16 (green) vs ≥16 (blue) distribution in the four groups: absent (0), presence of any one (1), two (2), or all (3) of the following: high grade (G3), high NLR ≥ 2.15, or high Ki-67 (>20) (B).

Figure 4 Disease-free survival of patients with neutrophil-to-lymphocyte ratio (NLR) of <2.15 vs ≥2.15 (A), NLR <1.22 vs ≥1.22 (B), Oncotype Dx (ODX RS) <26 vs ≥26 (C), and ODX RS <16 vs ≥16 (D).