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Neutrophil / Lymphocyte Ratio (NLR) ��? Trombocyte / Lymphocyte Ratio (TLR): A Predictor of Axillary Lymph Node Metastasis in Breast Cancer Patients?- Tugba Han �?�?ner- Baskent University School of Medicine

 Tugba Han Öner

 Introduction: Sentinel lymph node biopsy is the standard application for assessing axillary disease in   breast cancer patients. The Z0011 study by the Amer- ican College of Surgeons Oncology Group (ACOSOG)   emphasizes that axillary dissection (AD) is not re- quired in selected patients with positive sentinel   lymph nodes (SLN) [1]. It is known that axillary lymph node status is an important prognostic indicator in patients with invasive breast cancer [2,3]. Sentinel lymph node biopsy (SLNB) has been reported to cause   fewer complications than axillary lymph node dissec- tion (ALND), although extensive studies have shown   wound infection, seroma, hematoma, paresthesia, and allergic reactions to isosulfan blue dye [4,5]. As components of the systemic inflammatory response,   lymphocytes, neutrophils, and platelets are increas- ingly accepted as playing an important role in car- cinogenesis and tumor progression [6]. Neutrophil   / lymphocyte ratio (NLR), trombocyte / lymphocyte   ratio (TLR) and Glasgow Prognostic Score are prog- nostic markers in cancer [7]. High NLR (> 3.3) is asso- ciated with larger tumors and later stages [8]. Simi- larly, high TLR has been reported to adversely affect   survival in gastrointestinal cancers [9]. NLR and TLR reflect systemic inflammation and have independent prognostic value for various cancer patients [6,10].   However, the role of these biomarkers in breast can- cer prognosis is less well known. Researchers have   questioned whether NLR and TLR help to predict the axillary situation. This study therefore evaluated the   relationships between preoperative NLR, TLR, clini- copathological factors, and axillary lymph node me- tastasis in stage I-III breast cancer.   Patients and Methods: The study recruited 158 Stage   I-III breast cancer patients operated on at Baskent University Zubeyde Hanim Research Center between   2011 and 2018. Sentinel lymph node biopsy and ax- illary lymph node clearance in the presence of senti- nel lymph node metastasis was performed on all the   patients. Their medical records were examined and   their medical history, age, radiological and patholog- ical results, and laboratory data were collected. Pa- tients who had received chemotherapy or received   immunosuppressive drugs, such as glucocorticoids,   cyclosporine, tacrolimus, or interferon, were exclud- ed. The pathological data were analyzed and size of   tumor, histological grade, axillary lymph node status, hormone receptor status, Cerb B2 status, presence of lymphovascular invasion (LVI) and Patients and   Methods perineural invasion (PNI), radiological re- sults, and laboratory data were evaluated. Estrogen   receptor (ER) and progesterone receptor (PR) status were studied immunohistochemically (IHC). Venous blood samples were taken just before surgery. The   ratio of neutrophil and trombocyte count to lympho- cyte count, and NLR cut-off values were calculated   for both 3.5 and 1. Statistical analysis: Data were analyzed using SPPS 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.).   Mean ± standard deviation, percentage and frequen- cy values of the variables were used. Variables were   evaluated after checking for normality and homoge- neity of variances (Shapiro Wilk and Levene Test).   The analysis showed that the prerequisites for inde- pendent 2-group t test (Student’s t test) where not   met, so Mann Whitney-U test was used to compare the two groups. Categorical data were analyzed