The prognostic value of neutrophil/lymphocyte ratio (NLR) for HER2-positive metastatic breast cancer (MBC) is not well studied. This study aims to evaluate the prognostic role of baseline NLR in HER2-positive MBC patients treated with trastuzumab/pertuzumab.
The clinical data of 780 patients from CLEOPATRA were applied from VIVLI platform, and 248 HER2-postive MBC were collected from six local hospitals. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses were used to control bias. The associations between clinicopathological factors, NLR and progression-free survival (PFS) and overall survival (OS) were analyzed by univariate and multivariate analyses.
After PSM or IPTW adjustment, the subgroups were similar. Low baseline NLR was prognostic with better PFS and OS in the TH group in raw, PSM and IPTW models. Upon IPTW, low NLR, versus high NLR, was associated with improved PFS (HR 1.35, 95% CI 1.07-1.70, P = 0.012) and OS (HR 1.47, 95% CI 1.12-1.94, P = 0.006) in the TH group. In the THP group, low baseline NLR was also correlated with better PFS, but not for OS in the three models. After IPTW, patients with low NLR were associated with better PFS (HR 1.52, 95% CI 1.20-1.93, P = 0.001) comparing that with high NLR. Multivariate analyses showed that low baseline NLR was a predictor for PFS and OS in TH group, and PFS in the THP group in the three models. In the real-world study, low baseline NLR was a predictor of better PFS among patients with trastuzumab plus docetaxel or trastuzumab plus pertuzumab plus docetaxel therapy (P = 0.025 and 0.009 respectively).
Low baseline NLR is associated with better survival outcome among HER2-positive MBC receiving docetaxel plus trastuzumab or docetaxel plus trastuzumab plus pertuzumab as first-line therapy. Re-analyses of prospective randomized studies are needed to verify the role of baseline NLR in HER2-positive MBC treated with trastuzumab/pertuzumab.
Natural Science Foundation of Hunan Province (S2019JJKWLH0198, 2021JJ31094, 2021JJ31099) and Natural Science Foundation of Changsha City (KQ2007058).
All authors have declared no conflicts of interest.