Our study was to determine whether inflammatory marker were predictive factors in male breast cancer patients. However, we could not find predictive or prognostic value of NLR, PLR and LMR in this retrospective analysis. Recently, many articles have investigated blood indicators in patients with malignant tumors, the relationship between them is usually a multifactorial and complex process, still poorly understood. They concluded that tumor-associated neutrophil promote remolding of the extracellular matrix, which results in the release of fibroblast growth factor, migration of endothelial cells and the split of tumor cells; in addition, neutrophil-derived reactive oxygen species could inhibit the cytotoxic activity of lymphocytes, reduce the promoting of the extracellular matrix, suppress apoptosis of cancer cells. These events finally enhanced angiogenesis, and tumor growth and influenced survival outcomes in patients with cancer.[9–10] hile lymphocytes play an important role in the immune reaction against tumors, patients with cancer had higher densities of tumor-infiltrating lymphocytes, they could advance responses to treatments and improve outcome.[11–13] As systematic inflammatory markers, serum low lymphocyte and high neutrophil, platelet, macrophage counts have been recognized as worse prognosis in solid tumors. When coupled with these indicators, such as NLR, PLR, and LMR, the predictive effect on cancer prognosis may be enhanced. Several studies consistently had found that NLR was an unfavorable prognostic indicator in patients with gynecological, lung, gastrointestinal, and renal cancers. [14–19] A meta-analysis including 8,586 esophageal squamous cell carcinoma patients had reported that high NLR, PLR and low LMR were associated with poorer prognosis.
There were also lots of researches in breast cancer, Azab et al studied 465 female breast cancer patients and demonstrated significantly worse prognosis in patients with higher NLR. Several other studies have also shown similar findings. [21, 22] A recent meta-analysis which included eight researches published has shown that higher NLR may associated with poor surviaval. [22–24] It is worth noting that the available data mainly concern female patients.
For the first time, it enrolled an amount of male patients to investigate the prognostic role of these inflammatory markers in male breast cancer patients. In our study, we identified 108 male patients who were diagnosed and underwent breast surgery, after mean follow-up of 86 months, we found that whether DFS or not OS, the serum NLR or PLR or LMR were not statistically significant with these patients prognosis. This was not the same as in the women's study. As breast cancer is a complicated and heterogeneous disease, lots of clinical parameters or biomarkers have been confirmed to be associated with the prognosis of patients, such as hormone status, Her-2 status, and TNM stage. Studies had found that NLR, PLR, and LMR were just systemic inflammatory response related markers and may affect the prognosis in different cancers. In some case, these inflammatory markers may even contradict each other. Subsequently, we did a subgroup analysis, whether in HR positive group nor in HR negative group, we could not find these marks related to the prognosis of patients. It was different in female patients, Orditura M et al showed that higher NLR could lead to worse prognosis in female patients with early breast cancer,  while Yuka Asano et al reported that lower NLR may cause higher efficacy and better outcome after neoadjuvant chemotherapy in triple negative breast cancer patients . An additional analysis was made according to different HER-2 status, even in different groups we could not identify NLR, PLR, LMR as a predictive factor for prognosis. For male breast cancer patients is rare, treatment standards or prognostic indicators for them have generally been derived from female patients. However, breast cancer is a highly heterogeneous disease, some inflammatory biomarkers could predict the prognosis of patients with a woman, not suitable for male patients. Moreover, gender differences may affect patient preferences and survival factors. Therefore, it could need more studies independent in male patients to improve their therapy and prolong survival.
There are some limitations in our analysis. Firstly, this is a retrospective study with manual data extraction and analysis. However, data concerning laboratory values and survival data were not missed. Secondly, this was a mono-center study, all male patients eligible were included, it may also have the risk of a patient selection bias. Furthermore, serum samples of patients were collected uniformly before treatment to avoid false blood parameters. However, in our study, the number of patients and events were relatively small and did not allow to comprehensive multivariable analyze and preclude definitive conclusions, further multiple center and prospective studies still required.