PURPOSE The aim of this study was to investigate the prognostic impact of two systemic inflammatory markers, the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MLR), and their possible predictive role regarding the efficacy of adjuvant trastuzumab, in 209 early breast cancer cases, 107 of which were HER2-positive. METHODS Baseline NLR and MLR values were divided into two groups, high and low, according to cut-off-points determined from the ROC curve (2.2 for NLR and 0.22 for MLR). Cox's model was utilized for survival analyses. RESULTS High NLR and MLR correlated with poor overall survival (OS) and breast cancer specific survival (BCSS) among all the patients (p ≤ 0.030). Among the HER2+ patients whose adjuvant treatment did not include trastuzumab (n = 64), the survival rates were remarkably lower in patients with a high NLR as compared to those with low; 31% vs. 71% for OS and 42% vs. 74% for BCSS (p ≤ 0.014). Similarly, high MLR correlated with poor survival among these patients (p ≤ 0.020). On the contrary, among the patients who had received adjuvant trastuzumab (n = 43), NLR or MLR did not correlate with survival. Furthermore, trastuzumab was beneficial for the HER2+ patients with high NLR/MLR, while the survival of the HER2+ patients with low NLR/MLR was good irrespective if they received adjuvant trastuzumab. CONCLUSIONS Our results suggest that trastuzumab modulates the systemic inflammatory conditions and overcomes the poor prognostic impact of high NLR/MLR. This finding may also provide a rationale for combining trastuzumab with immuno-oncological treatments in HER2+ breast cancer.

中文翻译：

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中性粒细胞与淋巴细胞比率和单核细胞与淋巴细胞比率在早期乳腺癌中的预后和预测作用，尤其是在 HER2+ 亚型中。

目的 本研究的目的是调查两种全身炎症标志物，中性粒细胞与淋巴细胞比率 (NLR) 和单核细胞与淋巴细胞比率 (MLR) 的预后影响，以及它们对佐剂疗效的可能预测作用。曲妥珠单抗，在 209 例早期乳腺癌病例中，其中 107 例为 HER2 阳性。方法 根据从 ROC 曲线确定的截止点（NLR 为 2.2，MLR 为 0.22），将基线 NLR 和 MLR 值分为两组，高和低。Cox 模型用于生存分析。结果 在所有患者中，高 NLR 和 MLR 与较差的总体生存率 (OS) 和乳腺癌特异性生存率 (BCSS) 相关 (p ≤ 0.030)。在辅助治疗不包括曲妥珠单抗的 HER2+ 患者中（n = 64），与低 NLR 患者相比，高 NLR 患者的生存率显着降低；OS 为 31% 与 71%，BCSS 为 42% 与 74%（p ≤ 0.014）。同样，在这些患者中，高 MLR 与较差的存活率相关（p ≤ 0.020）。相反，在接受曲妥珠单抗辅助治疗的患者（n = 43）中，NLR 或 MLR 与生存率无关。此外，曲妥珠单抗对高 NLR/MLR 的 HER2+ 患者有益，而低 NLR/MLR 的 HER2+ 患者无论是否接受辅助曲妥珠单抗，其生存率都很好。结论 我们的结果表明曲妥珠单抗可调节全身炎症状况并克服高 NLR/MLR 对预后的不良影响。这一发现也可能为将曲妥珠单抗与 HER2+ 乳腺癌的免疫肿瘤治疗相结合提供了依据。