Relationship between platelet-lymphocyte ratio and tumour infiltrating lymphocyte on metastatic in breast cancer patient

Indro Wibowo Sejati, Ida Bagus Tjakra Wibawa Manuaba, Putu Anda Tusta, Gede Budhi Setiawan


Background: Platelet-lymphocyte ratio (PLR) is known associated with the prognosis of distant metastatic breast cancer. Tumor-infiltrating lymphocyte (TIL) in breast cancer also associated with the prognosis of distant metastatic breast cancer. In this study, we will examine the relationship between PLR and TIL, in association with the metastatic incidence in breast cancer.

Methods: This research is a retrospective, analytic, cross-sectional study. Data was taken from medical records of breast cancer patients at Sanglah general hospital. Samples were taken by nested sampling by selecting all breast cancer patients from the period of January 1st, 2017, to December 31st, 2018, which had complete medical record data, with total sample 211. The PLR and TIL were calculated and analyzed in relation to metastasis incidence of breast cancer.

Results: The sample characteristics were sorted by age, education, occupation, the area of origin, menstrual status, breast cancer staging, breast cancer subtype, TIL levels, lymphovascular invasion (LVI) status, metastatic status, and breast cancer grading. The data were analyzed to know the association of PLR, TIL, confounding factors in relation to metastatic incidences. In the sample group with PLR ≥ 156 10µ /µL, there were 22.9% cases of metastases (p = 0.002). The sample group at low TIL had metastatic event 12.5% with (p=0.442).

Conclusions: PLR was associated with higher metastasis in breast cancer patients and low TIL had no association with breast cancer metastasis.


Breast cancer, Metastasis, PLR, TIL

Full Text:



Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Globocan 2012 v1.0, Cancer incidence and mortality worldwide: IARC cancer base no. 11. Lyon, France. Int Ag Res Canc. 2013.

Union for international cancer center. New global cancer data: Globocan 2018. Available at: Accessed on: 10th December 2018.

Soysal SD, Tzankov A, Muenst SE. Role of the tumor microenvironment in breast cancer. Pathobio. 2015;82:142-52.

Hanahan D, Coussens LM. Accessories to the crime: functions of cells recruited to the tumor microenvironment. Canc Cell. 2012;21(3):309-22.

Purushotham A, Shamil E, Cariati M, Agbaje O, Muhidin A, Gillett C, Holmberg L. Age at diagnosis and distant metastasis in breast cancer - A surprising inverse relationship. Europ J Canc. 2014;50(10):1697-705.

American cancer society. Breast cancer facts and figures 2013-2014. Atlanta: American cancer Society. 2013. Available at Accessed on: 30th November 2018.

Cardoso F, Costa A, Norton L, Cameron D, Cufer T, Fallowfield L, et al. 1st International consensus guidelines for advanced breast cancer (ABC 1). Breast. 2012;21(3):242-52.

DeNardo DG, Brennan DJ, Rexhepaj E, Ruffell B, Shiao SL, Madden SF, et al. Leukocyte complexity predicts breast cancer survival and functionally regulates response to chemotherapy. Cancer Discov. 2011. Available at:

Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer. 2015;113(1):150-8.

Bahgat T. Breast cancer prognostication with neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Al-Azhar Assiut Med J. 2017;15;179.

Krenn-Pilko S, Langsenlehner U, Thurner EM, Stojakovic T, Pichler M, Gerger A, et al. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. Br J Cancer. 2014;110:2524.

Gay LJ, Felding-Habermann B. Contribution of platelets to tumour metastasis. Nat Rev Cancer. 2011;11:123.

Leblanc R, Peyruchaud O. Metastasis: new functional implications of platelets and megakaryocytes. Blood. 2016;128(1):24. Available at:

Templeton AJ, Ace O, McNamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204.

Zhu Y, Si W, Sun Q, Qin B, Zhao W, Yang J. Platelet-lymphocyte ratio acts as an indicator of poor prognosis in patients with breast cancer. Oncotarget. 2016;8(1):1023-0.

Asano Y, Kashiwagi S, Onoda N, Noda S, Kawajiri H, Takashima T, et al. Platelet-lymphocyte ratio as a useful predictor of the therapeutic effect of neoadjuvant chemotherapy in breast cancer. PLoS One. 2016;11(7):e0153459. Available at:

Stanton SE, Disis ML. Clinical significance of tumor-infiltrating lymphocytes in breast cancer. J Immunother cancer. 2016;4:59. Available at:

Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, et al. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs working group 2014. Ann Oncol Off J Eur Soc Med Oncol. 2015;26(2):259-71. Available at:

Klahan S, Wong HS, Tu S, Chou W, Zhang Y, Ho T, et al. Identification of genes and pathways related to lymphovascular invasion in breast cancer patients : A bioinformatics analysis of gene expression profiles. 2017. Tumour Biol. 2017 Jun;39(6):1010428317705573.

Wongrakpanich S, George G, Chaiwatcharayut W, Candelario N, Mittal V, Pomerantz S, et al. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with multiple myeloma: a retrospective study. Blood. 2015 Dec 3126(23):1776. Available at:

Bhatia JK, Metzger D, Ashamalla H, Katsoulakis E, Mattes MD. Breast cancer molecular subtype as a predictor of lymph node metastasis. Int J Radiat Oncol Biol Phys. 2014;90(1):S267-8.

Cserni G. Tumour histological grade may progress between primary and recurrent invasive mammary carcinoma. J Clin Pathol. 2002;55(4):293-7.

Porter GJR, Evans AJ, Pinder SE, James JJ, Cornford EC, Burrell HC, et al. Patterns of metastatic breast carcinoma: influence of tumour histological grade. Clin Radiol. 2004;59(12):1094-8.

Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood. 2015;126(5):582-8.

Shankaran V, Ikeda H, Bruce AT, White JM, Swanson PE, Old LJ, et al. IFNγ and lymphocytes prevent primary tumour development and shape tumour immunogenicity. Nature. 2001;410(6832):1107-11.

Mahmoud S, Lee A, Ellis I, Green A. CD8+ T lymphocytes infiltrating breast cancer. Oncoimmunol. 2012;1(3):364-5.

Mao Y, Qu Q, Chen X, Huang O, Wu J, Shen K. The prognostic value of tumor-infiltrating lymphocytes in breast cancer: A systematic review and meta-analysis. PLoS One. 2016;11(4):1-13.

Faria SS, Fernandes PC, Silva MJB, Lima VC, Fontes W, Freitas R, et al. The neutrophil-to-lymphocyte ratio: A narrative review. Ecancer Med Sci. 2016;10:1-2.

Kashiwagi S, Asano Y, Goto W, Takada K, Takahashi K, Noda S, et al. Use of tumor-infiltrating lymphocytes (TILs) to predict the treatment response to eribulin chemotherapy in breast cancer. PLoS One. 2017;12(2):e0170634.

Liu C, Huang Z, Wang Q, Sun B, Ding L, Meng X, et al. Usefulness of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hormone-receptor-negative breast cancer. Onco Targets Ther. 2016;9:4653-60.

Wahidin, Mugi, Palupi NW, Sulistyowati LS. Situation of breast cancer in Indonesia and its controlling efforts. In: Sobri FB, Azhar, Yohana, Wibisana IGNG, ed. Current management of breast cance. ed.1st Jakarta. Media Aeskulapius. 2017:1-9.

Infodatin. Cancer situation. RI ministry of health. 2012:4. Available at