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Background Different peripheral blood markers have been reported to be involved in different stages of breast cancer development and metastasis. However, the association between NLR, LDH and prognosis of pyrotinib in HER2-positive metastatic breast cancer (mBC) remains unknown. Methods We collected the clinical data and blood test results of 113 patients with HER2-positive mBC who were treated with pyrotinib at Chongqing University Cancer Hospital. The clinical data and blood test indexes were collected, and the ROC curve determined the optimal cut-off value. Kaplan-Meier survival curve and Cox regression model was used to analyze the effect of different levels of NLR and LDH before T-DM1 treatment on the survival of patients. Results The optimal cut-off value of NLR and LDH was 2.44 (p=0.027) and 216.5U/L (p=0.033), respectively. With a median follow-up of 49.0 months (95%CI: 44.2-53.8), the median PFS and OS were 12.0 months (95%CI: 8.9-15.1) and 36.0 months (95%CI: 30.12-41.88), respectively. High NLR was associated with only a trend toward worse PFS (low-NLR vs high-NLR: 14.0 months vs 11.0 months, p=0.095). While patients with low LDH had a significantly longer PFS (19.0 months) than patients with high LDH (10.0 months, p0.001). Higher NLR or LDH were significantly correlated with shorter median OS (low-NLR vs high-NLR: not reach (NR) vs 33.0 months, p=0.021; low-LDH vs high-LDH: NR vs. 30.0 months, p=0.002). Multivariable models showed that LDH was the only covariate independently associated with worse PFS (p=0.002), while high LDH (p=0.021), high NLR (p=0.007) and postmenopause (p=0.034) were independently associated with worse OS. Conclusions Serum NLR and LDH were prognostic risk factors for metastatic HER2 positive breast cancer patients treated with pyrotinib. Elevated NLR and LDH were associated with poor PFS and OS. Future data are needed to validate and update our results.
Zhou et al. (2026) studied this question.