Abstract P3-07-38: Increment of neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive markers for the metastatic breast cancer (MBC) with first line hormonal therapy (HT)
Authors: Miyamoto T , Fujisawa T , Morishita A , Yanagita Y , Kuwano H 
Published: May 2016

Abstract
[Introduction] Cancer microenvironment formed by the immune and inflammatory cells is noticed to be one of the factors for tumor growth, invasion or metastasis. To figure out the systemic inflammatory environment, the neutrophil / lymphocyte ratio (NLR) is a useful method and a simple indicator. We have some reports that NLR can predict the prognosis in many malignancies, including breast cancer, as I reported in SABCS 2014, however, NLR cannot be a predictive marker in major cancers, because the usage with anti-cancer agents will make NLR status out of order. In hormonal receptor positive metastatic breast cancer (HR+ve MBC), we choice hormonal therapy (HT) for the first line, mainly. HTs have little influence for NLR, therefore, the change of NLR, increment or decrement, can reflect the systemic inflammatory status and be a useful predictive marker for the HR+ve MBC with HTs.
[Purpose] I define dNLR as the difference between NLR at the 2-3 months after HT and before HT. To evaluate the dNLR affects the Overall Survival (OS) and Progression Free Survival (PFS) of the patients of MBC or not.
[Patients] From 2003 to 2013, we have 299 MBC patients in our hospital. Out of them, 134 patients had HTs as first line, included 18 Stage4 patients at the first visit. Median Disease free survival (DFS) is 1497-day, the median OS after the recurrence is 1472-day. Average value of the NLR before HT is 2.62. The reasons of MBC are bone metastases (mets), pleural and pulmonary mets, liver mets, lymph node mets, central nervous system (CNS) mets, unresectable metastatic chest wall recurrence, or other.
[Results] By univariate analysis, DFS &lt; 1000 (p&lt;0.01) and liver mets (p&lt;0.05) made a contribution to poor OS. dNLR&gt;=0.5 (p&lt;0.05), liver mets (p&lt;0.05) and 2 or more organs involvements (p &lt; 0.05) made a contribution to poor PFS. With multivariate analysis, for OS, only DFS &lt; 1000 was an independent prognostic factor. And for PFS, only dNLR&gt;=0.5 was an independent predictive factor. Poor OS factors by univariate analysis had no influence for PFS as well as poor PFS factors did not reflect the OS.
[Discussion] The dNLR was a predictive marker for HR+ve MBC which we can easily and simply examine by blood sample. Now we cannot reveal the relationship with dNLR and OS, however, this fact suggests that we can decide to stop the first line HT and select the second line therapy using with not only images or tumor makers but also dNLR. This can certainly contribute for good OS. It remains some questions between dNLR and other examinations, for example, which can detect the patient status earlier and more accurate? First, we need to accumulate further retrospective cases and plan the prospective study to make sure of the adequate treatment divided by dNLR.
[Conclusion] The dNLR&gt;=0.5 is one of the independent predictive markers for HR+ve MBC with first line HT.
Citation Format: Miyamoto T, Fujisawa T, Morishita A, Yanagita Y, Kuwano H. Increment of neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive markers for the metastatic breast cancer (MBC) with first line hormonal therapy (HT). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-38.