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Purpose <p>The neutrophil-to-lymphocyte ratio (NLR) is a readily available inflammatory biomarker for predicting febrile neutropenia (FN) in cancer patients. This study aimed to evaluate the association between pretreatment NLR and the risk of FN in breast and ovarian cancer patients.</p> Methods <p>In this prospective study, 130 patients (109 breast, 21 ovarian) were analyzed. Pretreatment NLR was measured, and the optimal cutoff was determined using receiver operating characteristic (ROC) curve analysis. Clinical and pathological variables, including age, body surface area (BSA), chemotherapy regimen, chemotherapy setting, cancer type, and stage, were assessed using univariate analyses, followed by parsimonious multivariable models adjusting for selected clinical covariates. Internal validation was performed using bootstrap resampling. Subgroup analyses were conducted according to cancer type, chemotherapy regimen, and treatment setting.</p> Results <p>ROC analysis showed an area under the curve (AUC) of 0.628 (95% CI 0.511–0.746) for NLR. An NLR cutoff ≥ 2.1 demonstrated a sensitivity of 72.7%, specificity of 50%, positive predictive value of 27.9%, negative predictive value of 90%, and showed a borderline association with FN in univariate analysis (OR 2.67, 95% CI 0.97–7.33, <i>p</i> = 0.057). This association was not consistently significant after adjustment or across subgroup analyses. Bootstrap validation demonstrated stability of the estimated effects without materially altering statistical significance. Other clinical variables, including age, body surface area, cancer type, stage, and chemotherapy regimen, were not significantly associated with FN.</p> Conclusion <p>Pretreatment NLR demonstrated a trend toward association with chemotherapy-induced FN; however, its discriminatory performance was limited, and statistical significance was not consistently achieved. These findings suggest that NLR may reflect an underlying inflammatory signal but is insufficient as a standalone predictive marker. Further validation in larger external cohorts is warranted before clinical application can be considered.</p>

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Pretreatment neutrophil-to-lymphocyte ratio (NLR) as a potential risk marker for febrile neutropenia (FN) in breast and ovarian cancer during first-cycle chemotherapy

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Faraz Saif,
  • Fakhra Nain Qureshi,
  • Azaz Ahmad,
  • Fakeeda Durrani,
  • Noor Ul Ain Azam,
  • Imad Ullah,
  • Zia Ud Din Ahmed,
  • Asif Riaz Khan

摘要

Purpose

The neutrophil-to-lymphocyte ratio (NLR) is a readily available inflammatory biomarker for predicting febrile neutropenia (FN) in cancer patients. This study aimed to evaluate the association between pretreatment NLR and the risk of FN in breast and ovarian cancer patients.

Methods

In this prospective study, 130 patients (109 breast, 21 ovarian) were analyzed. Pretreatment NLR was measured, and the optimal cutoff was determined using receiver operating characteristic (ROC) curve analysis. Clinical and pathological variables, including age, body surface area (BSA), chemotherapy regimen, chemotherapy setting, cancer type, and stage, were assessed using univariate analyses, followed by parsimonious multivariable models adjusting for selected clinical covariates. Internal validation was performed using bootstrap resampling. Subgroup analyses were conducted according to cancer type, chemotherapy regimen, and treatment setting.

Results

ROC analysis showed an area under the curve (AUC) of 0.628 (95% CI 0.511–0.746) for NLR. An NLR cutoff ≥ 2.1 demonstrated a sensitivity of 72.7%, specificity of 50%, positive predictive value of 27.9%, negative predictive value of 90%, and showed a borderline association with FN in univariate analysis (OR 2.67, 95% CI 0.97–7.33, p = 0.057). This association was not consistently significant after adjustment or across subgroup analyses. Bootstrap validation demonstrated stability of the estimated effects without materially altering statistical significance. Other clinical variables, including age, body surface area, cancer type, stage, and chemotherapy regimen, were not significantly associated with FN.

Conclusion

Pretreatment NLR demonstrated a trend toward association with chemotherapy-induced FN; however, its discriminatory performance was limited, and statistical significance was not consistently achieved. These findings suggest that NLR may reflect an underlying inflammatory signal but is insufficient as a standalone predictive marker. Further validation in larger external cohorts is warranted before clinical application can be considered.