Combination of the preoperative albumin to globulin ratio and neutrophil to lymphocyte ratio as a novel prognostic factor in patients with triple negative breast cancer

Qijia Xuan, Yan Yang, Hongfei Ji, Shuli Tang, Juan Zhao, Jiayue Shao, Jingxuan Wang, Qijia Xuan, Yan Yang, Hongfei Ji, Shuli Tang, Juan Zhao, Jiayue Shao, Jingxuan Wang

Abstract

Background: The pretreatment albumin to globulin ratio (AGR) and neutrophil to lymphocyte ratio (NLR) were the inflammation-associated factors which were related to the disease-free survival in various malignancies. The aim of this study was to evaluate the clinical significance of the pretreatment AGR combined with NLR for patients with triple negative breast cancer (TNBC). Method: This retrospective study included 286 cases of pathologically diagnosed patients with TNBC. The relationships of AGR and NLR with clinicopathologic characteristics and prognosis were analyzed by Kaplan-Meier and Cox regression methods. Results: An AGR of 1.63 and a NLR of 2.93 were identified as the optimal cut-off points for distinguishing patients with good versus poor prognosis. The area under the receiver operating characteristic curves of combined with AGR and NLR (CO-AN) was increased compared with AGR and NLR individually. Kaplan-Meier analysis showed that low AGR/high NLR was related to poor survival. The prognosis of patients can be predicted well by the CO-AN. Univariate and multivariate analyses revealed that high AGR levels, low NLR levels, and CO-AN<1 were significantly and independently associated with favorable disease-free survival. Conclusions: Our study suggested that AGR and NLR levels can be prognostic biomarkers for disease-free survival in patients with TNBC. The CO-AN may have greater predictive value than AGR and NLR in patients with TNBC.

Keywords: albumin-to-globulin ratio; neutrophil–lymphocyte ratio; prognostic factor; triple negative breast cancer.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
ROC curves assessing the cut-off of AGR and NLR for predicting the occurrence of disease events in the study. Abbreviations: AGR, albumin-to-globulin ratio; NLR, neutrophil–lymphocyte ratio; CO-AN, combination of decreased AGR and increased NLR.
Figure 2
Figure 2
Kaplan-Meier curves for DFS according to optimal cutoff points of AGR and NLR. (A) AGR. (B) NLR. Abbreviations: DFS, disease-free survival; AGR, albumin-to-globulin ratio; NLR, neutrophil–lymphocyte ratio.
Figure 3
Figure 3
Kaplan-Meier curves for DFS according to optimal cutoff points of CO-AN. Abbreviation: DFS, disease-free survival; CO-AN, combination of AGR and NLR.

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