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Original Research

Open Access

Association of anemia and neutrophil-lymphocyte ratio with overall survival in breast cancer patients

  • Rafael de Carvalho da Silva1
  • Raphael Elias Ferreira1
  • Tatiana Castrillon Guaresqui1
  • Lúcia Marina Scatena2
  • Beatriz Martins Tavares-Murta3
  • Eddie Fernando Candido Murta1
  • Rosekeila Simões Nomelini1,*,

1Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba-MG, Brazil

2Department of Collective Health, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba-MG, Brazil

3Discipline of Pharmacology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba-MG, Brazil

DOI: 10.22514/ejgo.2022.014 Vol.43,Issue 3,June 2022 pp.97-102

Submitted: 23 January 2022 Accepted: 13 April 2022

Published: 15 June 2022

*Corresponding Author(s): Rosekeila Simões Nomelini E-mail:;


Objective: The neutrophil-lymphocyte ratio (NLR) has been shown to correlate with disease progression and survival in a number of cancers. In this study we explore this ratio and a number of other blood-derived factors, including platelet-lymphocyte ratio (PLR) and hemoglobin levels, for their prognostic value with overall survival in breast cancer patients. Methods: A retrospective study was conducted with data from the medical records of patients with breast cancer (n = 303) collected from a breast cancer treatment and research clinic. The data included clinical staging at diagnosis, tumor size, axillary lymph node involvement, presence or absence of metastases, tumor histology, tumor grade, hormone receptor, treatments received (surgery, chemotherapy, hormonotherapy), overall survival, NLR, PLR, anemia, leukocytosis, neutrophilia, and lymphopenia. Cox regression was used to verify the influence of the variables on five-year overall survival of patients following their initial diagnosis. Results: Patients with NLR >4 showed association with staging >II (p < 0.05), with the presence of metastasis (p < 0.0001), and with negative hormone receptor (p < 0.0001). A hemoglobin <12 g/dL associated with staging >II (p < 0.0001), with the presence of metastasis (p < 0.0001), and with negative hormone receptor (p < 0.05). High values of NLR and PLR were associated with shorter overall survival by Kaplan-Meier survival curves (p < 0.001 and p = 0.021, respectively). After multivariate regression, tumor size, lymph node status, metastasis, NLR and anemia remained as factors that independently influenced mortality at 5 years. NLR >4 increased the risk of death by 7.76 times (p < 0.001) and hemoglobin <12 mg/d increased the risk of death by 2.47 times (p = 0.037). Conclusions: NLR and anemia are factors that independently correlate with overall survival in breast cancer patients. These factors have the advantage of being derived from simple and inexpensive blood testing.


Neutrophil-lymphocyte ratio; Anemia; Hemoglobin; Overall survival; Breast cancer

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Rafael de Carvalho da Silva,Raphael Elias Ferreira,Tatiana Castrillon Guaresqui,Lúcia Marina Scatena,Beatriz Martins Tavares-Murta,Eddie Fernando Candido Murta,Rosekeila Simões Nomelini. Association of anemia and neutrophil-lymphocyte ratio with overall survival in breast cancer patients. European Journal of Gynaecological Oncology. 2022. 43(3);97-102.


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