Hemoglobin level and neutrophil-to-lymphocyte ratio as prognostic peripheral blood markers of survival outcomes in sacituzumab govitecan therapy for mTNBC in Polish female cohort.

Abstract

e13152 Background: Hemoglobin (Hb) level and the neutrophil-to-lymphocyte ratio (NLR) are key prognostic factors in breast cancer, influencing survival and disease progression. Anemia linked to tumor hypoxia, drive aggressive cancer behavior and reduce treatment efficacy, while elevated NLR reflects systemic inflammation and correlates with advanced disease. These factors may guide the use of novel therapies, such as sacituzumab govitecan (SG), which has significantly improved outcomes in metastatic triple-negative breast cancer (mTNBC). Identifying accessible prognostic markers is essential for optimizing treatment strategies in this challenging patient population. Methods: The study included 83 Polish women treated with SG across four oncological centers. Clinical data were collected retrospectively, and morphological parameters were assessed on day 1 of cycle I (D1CI). Hb was measured in grams per deciliter (g/dL), while N and L were measured in grams per liter (g/L). The NLR was determined by dividing the number of neutrophils by the number of lymphocytes. Anemia grades were defined according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5. Statistical analyses involved multivariate Cox regression for progression-free survival (PFS) and overall survival (OS). Results: The study included patients with a mean age of 55.07 years at the start of treatment. SG therapy was administered across multiple lines of treatment, with a median of 2 lines (range: 1–6) and a median of 5 completed cycles. The median PFS was 4.07 months, while the median OS was 8.01 months. Analysis of Hb levels revealed that at D1C1the distribution of hemoglobin levels was as follows: 35 patients (42.17%) had normal Hb levels, 33 patients (39.76%) had grade 1 and 15 patients (18.07%) had grade 2. The median Hb level was 11.7 g/dL (SD 1.55 g/dL), while the median NLR was 3.42 (SD 3.30). Multivariate Cox regression analysis identified Hb as a statistically significant predictor of PFS, with lower Hb levels associated with shorter PFS (HR: 0.8223, p = 0.0267). However, Hb was not a significant predictor of OS (p > 0.05). In contrast, higher NLR was significantly associated with reduced OS (HR: 1.1847, p = 0.0278). Conclusions: Lower levels of Hb are associated with reduced PFS, suggesting a significant impact of anemia on disease progression. Higher levels of NLR are associated with reduced OS, indicating that systemic inflammation might play a critical role in patient prognosis. These findings highlight the need for further evaluation of baseline Hb and NLR as prognostic factors in a larger population before initiating SG therapy.