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April 5, 2026Cancer Research

Each doubling of pretreatment NLR is linked to ~24% worse recurrence-free survival.

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Why the study?

Prior studies rarely accounted for racial variation in baseline neutrophil-to-lymphocyte ratio values, which may affect threshold-based analyses in breast cancer.

Does pretreatment neutrophil-to-lymphocyte ratio predict survival outcomes in a multiethnic cohort of breast cancer patients?

Population

754 breast cancer patients from the Chicago Multiethnic Epidemiologic Breast Cancer Cohort

Comparison

Higher vs lower pretreatment NLR analyzed continuously, by cohort-wide median, and race-specific cutoffs

Design

Retrospective cohort study

Key result

Each doubling of pretreatment neutrophil-to-lymphocyte ratio was associated with worse recurrence-free survival (aHR 1.24; 95% CI 1.02-1.52), with predictive value varying by race and subtype.

Authors

AJArmaan JamalLCLi ChuJFJincong Q. Freeman

Discussion

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Overview

Race-specific NLR thresholds may refine risk stratification in Black breast cancer patients; extends prognostic evidence but remains hypothesis-generating pending validation.

Key Points

  • This research aims to assess the prognostic significance of pretreatment NLR in breast cancer, considering racial variations.
  • Conducted a retrospective analysis of 754 patients from the Chicago Multiethnic Epidemiologic Breast Cancer Cohort.
  • Evaluated NLR as both continuous and binary variables using cohort-wide and race-specific cutoffs.
  • Utilized Cox and competing risk regression models to estimate associations between NLR and survival outcomes.
  • Each doubling of NLR was associated with worse recurrence-free survival (RFS) and overall survival (OS).
  • High NLR significantly linked to higher other-cause mortality in Black patients.
  • Race-specific thresholds revealed significant associations between high NLR and worse outcomes in Black patients, particularly for HER2-negative and hormone receptor-positive tumors.

Study Design

Type

Cohort (n=754)

Structured PICO

Does pretreatment neutrophil-to-lymphocyte ratio predict survival outcomes in a multiethnic cohort of breast cancer patients?

P
Population
754 patients from the Chicago Multiethnic Epidemiologic Breast Cancer Cohort with an NLR measurement ≤1 year prior to treatment initiation, mean age 55.9 years, including 383 Black, 308 White, and 63 Other patients.
I
Intervention
Pretreatment neutrophil-to-lymphocyte ratio (NLR) evaluated as a continuous and binary variable
C
Comparator
Lower NLR values (evaluated continuously and using cohort-wide median cutoff of 2.07 or race-specific cutoffs)
O
Outcome
Recurrence-free survival (RFS), overall survival (OS), breast cancer-specific survival (BCSS), and other-cause (OC) mortalityhard clinical

Main Result

Effect estimate: aHR 1.24 (95% CI 1.02-1.52)

Pretreatment NLR is a prognostic marker for breast cancer outcomes, but its predictive value varies by race and tumor subtype, highlighting the need for race-specific thresholds.

Cite This Study

Jamal et al. (2026) conducted a cohort in Breast cancer (n=754). Pretreatment neutrophil-to-lymphocyte ratio (NLR) was evaluated on Recurrence-free survival (RFS) (aHR 1.24, 95% CI 1.02-1.52). Each doubling of pretreatment neutrophil-to-lymphocyte ratio was associated with worse recurrence-free survival (aHR 1.24; 95% CI 1.02-1.52), with predictive value varying by race and subtype.

synapsesocial.com/papers/69d1fe07a79560c99a0a4775https://doi.org/10.1158/1538-7445.am2026-5368
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