Engin HENDEM, Melek KARAKURT ERYILMAZ, Murat ARAZ, Mehmet ARTAÇ
Journal of Oncological Sciences - 2026;12(2):290-303
Objective: Systemic inflammatory response contributes to tumor progression and may influence survival outcomes in breast cancer. Blood-based inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), have been proposed as prognostic biomarkers. This study evaluated the prognostic value of pretreatment NLR, PLR, and SII across molecular subtypes of breast cancer. Material and Methods: This retrospective cohort study included 190 patients with invasive breast cancer who were treated between February 2012 and April 2022. Pretreatment NLR, PLR, and SII were calculated from complete blood counts. Optimal cut-off values were determined using a 60 months landmark receiver operating characteristic analysis. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method, the log-rank test, and Cox regression. Subgroup analyses were performed according to molecular subtype. Results: After a median follow-up of 58.8 months, 30 deaths (15.8%) and 44 DFS events (23.2%) occurred. Optimal cut-offs were 1.78 for NLR, 138.08 for PLR, and 449.55 for SII. In the overall cohort, elevated NLR was associated with numerically worse OS (hazard ratio [HR]=2.05; p=0.096) and DFS (HR: 1.78; p=0.088), although these associations did not reach statistical significance. In the triple-negative breast cancer subgroup, high NLR was associated with poorer OS (log-rank p=0.019) and DFS (log-rank p=0.025); however, ridge-penalized Cox estimates were imprecise [OS: HR=1.52, 95% confidence interval (CI)=0.42-5.57; DFS: HR=1.75, 95% CI=0.50-6.11]. Multivariate analysis identified Ki-67 >=20% and lymph node positivity as independent predictors of OS, while progesterone receptor positivity, Ki-67 >=20%, and Stage III independently predicted DFS. Conclusion: NLR was not independently prognostic in the overall cohort. Its association with survival outcomes in triple-negative breast cancer is preliminary and hypothesis-generating and requires validation in larger independent cohorts.
