Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictor of Axillary Lymph Node Metastasis in Patients with Breast Cancer

Abstract

Background: Axillary lymph node metastasis plays an important role in breast cancer prognosis and is a factor which is important in the decision-making process for therapy. The neutrophil-to-lymphocyte ratio (NLR), a readily available marker of systemic inflammation, has been gaining interest as a possible predictor of the aggressiveness of the tumor and metastatic involvement. It could have a role in the identification of axillary lymph node metastasis, which could help to enhance preoperative risk assessment.

Objective: To evaluate the association between preoperative neutrophil-to-lymphocyte ratio and axillary lymph node metastasis in patients with breast cancer and determine its predictive performance.

Material and Methods: This cross-sectional analytical study was conducted at the Department of General Surgery, Combined Military Hospital (CMH), Rawalpindi, from June 2023 to November 2023. 110 patients with histopathologically diagnosed breast cancer were recruited. Absolute counts of neutrophils and lymphocytes were used for the preoperative NLR. Axillary lymph node involvement was confirmed with the postoperative pathological examination of the nodes. The analysis of the data was performed on SPSS version 26. It was proposed that group comparisons, logistic regression and receiver operating curve (ROC) curve analysis be used to assess the association and predictive ability of NLR. A p-value of < 0.05 was deemed statistically significant.

Results: Among 110 patients, 39 (35.5%) had histopathologically confirmed axillary lymph node metastasis. The mean preoperative neutrophil-to-lymphocyte ratio (NLR) was significantly higher in node-positive patients compared with node-negative patients (3.29 ± 1.18 vs. 2.34 ± 0.84; p<0.001). On multivariable logistic regression analysis, NLR emerged as an independent predictor of axillary lymph node metastasis, with an adjusted odds ratio of 2.78 (95% CI: 1.66–4.63; p<0.001). Receiver operating characteristic (ROC) curve analysis an area under the curve (AUC) of 0.752, with a sensitivity of 71.8% and specificity of 63.4% at an NLR cutoff value of 2.5.

Conclusion: Preoperative NLR represents a potentially useful, inexpensive, and easily accessible biomarker for assessing axillary lymph node involvement in breast cancer. Its clinical usefulness should be evaluated alongside established clinicopathological characteristics and confirmed through validated predictive analyses.

Keywords: Axillary lymph node metastasis; Breast cancer; Neutrophil-to-lymphocyte ratio; Preoperative assessment; Systemic inflammation; Predictive biomarker.