AccScience Publishing / JCTR / Volume 11 / Issue 6 / DOI: 10.36922/JCTR025260030
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ORIGINAL ARTICLE

Association between the neutrophil percentage-to-albumin ratio and breast cancer risk: Evidence from the National Health and Nutrition Examination Survey 1999–2016

Xiaoying He1 ,  Tang Xiao2 ,  Haifang Zhao2 ,  Xinyue Huang2 ,  Sheng Xu1 ,  Junfeng Liu1 ,  Yunxiang Wang1 ,  Jie Yin2 ,  Yong Zhou1 ,  Rui Qi3 ,  Ruijuan Heng1* ,  Pan Qi1*
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1 Department of Head and Neck and Breast Surgery, Xinxiang Central Hospital, Xinxiang, Henan, China
2 Department of Pharmacology, School of Pharmacy, Xinxiang Medical University, Xinxiang, Henan, China
3 Department of Pharmacology, Zhengzhou Shuqing Medical College, Zhengzhou, Henan, China
JCTR 2025, 11(6), 64–75; https://doi.org/10.36922/JCTR025260030
Received: 23 June 2025 | Revised: 6 September 2025 | Accepted: 1 December 2025 | Published online: 17 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: Increasing evidence underscores the association between chronic inflammation and carcinogenesis. Aim: The aim of the study is to investigate the association between the neutrophil percentage-to-albumin ratio (NPAR) and breast cancer (BC) risk. Methods: This analysis utilized cross-sectional data from 16,993 participants enrolled in the National Health and Nutrition Examination Survey from 1999 to 2016. To investigate the link between NPAR and BC risk, weighted multivariate logistic regression models were applied. Nonlinear associations were explored using restricted cubic spline (RCS) models. Furthermore, a nomogram incorporating NPAR was constructed for risk stratification, and its predictive accuracy was evaluated using receiver operating characteristic curve (ROC) analysis. Results: After adjusting for potential confounders, elevated NPAR levels showed a significant positive association with BC (odds ratio [OR] = 1.12, 95% confidence interval [95% CI]: 1.08–1.16; p<0.001). Compared with the reference quartile (Q1), progressively increasing ORs associated with BC were observed across ascending NPAR quartiles: Q1: OR 1.05 (95% CI: 0.78–1.42), Q2: OR 1.35 (95% CI: 1.02–1.79), and Q3: OR 1.47 (95% CI: 1.12–1.93). Analysis using RCS indicated a linear relationship where increasing NPAR levels were associated with a higher risk of BC. The predictive model incorporating NPAR demonstrated strong accuracy for BC prediction, achieving an area under the ROC curve of 0.8068 (95% CI: 0.7904–0.8232). Conclusion: Our findings reveal a significant dose-dependent association between NPAR and BC risk in a nationally representative sample from the United States. Although cross-sectional designs preclude causal inference, longitudinal studies should validate these observations and explore underlying biological mechanisms. Relevance for patients: NPAR could potentially serve as a novel biomarker to predict BC risk in patients.

Keywords
National Health and Nutrition Examination Survey
Neutrophil percentage-to-albumin ratio
Breast cancer
Inflammatory marker
Funding
This study was supported by the Henan Provincial Medical Science and Technology Research Plan (Joint Construction Projects, Grant Numbers: LHGJ20200957 and LHGJ20210911), issued by the Henan Provincial Health Commission (Yu Wei Ke Jiao Han [2021] No. 1 and No. 39).
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
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