Abstract P3-07-10: Prognostic value of neutrophil-lymphocyte ratio in early breast cancer patients with ER+/Her2 negative and its association with 21 gen recurrence score
Authors: Maldonado-Noboa Ivan , Cabrera-Galeana Paula , Arce-Salinas Claudia , Lara María Elena , Cuamani-Mitznahuatl Gerardo , De Guevara Diego Ladron , Ordoñez Adan , Bargallo-Rocha Enrique 
Published: March 2020

Abstract
Background: Breast cancer (BC) is a heterogeneous disease, around 70% of these tumors are hormone receptor (HR) positive. The 21 gene recurrence score (RS) is a prognosis tool to define disease-free-survival in patients with early-stage HR+/HER2- BC with negative and positive lymph nodes also because its predictive value is used to decide the kind of adjuvant systemic treatment. The ability of malignant cells to progress and subsequently metastasize is not entirely dependent on their own intrinsic cellular signaling pathways but also of complex interactions with the tumor microenvironment and the innate and specific immune system. A high neutrophil to lymphocyte ratio (NLR) has been associated with lower overall survival (OS), disease-free survival (DFS) and distant disease-free survival (DDFS). Because both tools have evidence to evaluate prognosis. We propose that NLR would be a faster and cheaper alternative to achieved prognosis in low/middle-income countries. Objective: 1)Evaluated the association between NLR and RS to predict disease-free survival and distant disease-free survival in patients with early-stage HR+/HER2- BC. 2)Define the prognosis value to DFS and DDFS of NLR in patients with HR+/HER2- BC. Methods: We collected data from 208 patients with HR+/HER2- early BC treated with surgery upfront and RS has done. The recorded variable used were tumor size, nuclear grade, lymph node status. Regarding HR status, estrogen receptor (ER) positive was mandatory and progesterone receptor (PR) was exploratory. Complete blood count (CBC) test was obtained after BC diagnosis and prior to breast surgery. NLR was calculated as absolute neutrophil count divided by absolute lymphocyte count. The cut-off value used was 2.5. RS of each patient was categorized into a low-risk (≤ 25) or high-risk (&gt; 26). Disease-specific survival curves were calculated according to the Kaplan-Meier method and comparison was done with the log-rank test, the correlation between NLR and RS was assessed using Spearman’s rank correlation coefficient. Statistical analysis was performed by SPSS software v 23.0. Results: The median age was 61.1 years old (33-97), median tumor size 2,3 (0.5-5) cm, 92.8% were PR-positive, 71.5% had lymph node metastases (1-3), 159 (76%) patients had NLR &lt; 2.5. There was no difference in DFS 91.8 months vs 93.7 months p=0.44 neither in DDFS 92.9 months vs 94.6 months p=0.30 between groups by NLR. NLR did not correlate significantly with RS (Spearman’s r= 0.08, p=0.23). Correlation among NLR a PR, lymph node status, nuclear grade, and tumor size, was not significant. Low RS was associated with a DFS of 96% vs 87.8% in high RS (p=0.049) Conclusions: We failed to demonstrate the prognostic value of NLR for DFS in HR+/HER2- early breast cancer. NLR does not correlate with RS so, RS remains to be the most useful prognostic factor in this population.
Citation Format: Ivan Maldonado-Noboa, Paula Cabrera-Galeana, Claudia Arce-Salinas, María Elena Lara, Gerardo Cuamani-Mitznahuatl, Diego Ladron De Guevara, Adan Ordoñez, Enrique Bargallo-Rocha. Prognostic value of neutrophil-lymphocyte ratio in early breast cancer patients with ER+/Her2 negative and its association with 21 gen recurrence score [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-10.