Abstract P6-08-35: Pre-surgical neutrophil-to-lymphocyte ratio (NLR) is a prognostic indicator of recurrence free and overall survival in breast cancer patients undergoing primary surgery
Authors: O Connor Derbrenn , Griffin Mark L , O'Sullivan Jenna S , Millar Sean , O'Keeffe Jo , Bird Brian R , Deady Sandra , Murphy Conleth G 
Published: May 2015

Abstract
Background
There is growing evidence that elevated neutrophil-to-lymphocyte ratio (NLR) is an independent prognostic indicator associated with poor survival in various cancers including colon cancer, ovarian cancer, esophageal cancer and gastric cancer. Several studies in early breast cancer suggest that NLR at diagnosis may be an independent negative prognostic marker in this population also. The aim of the current study is to evaluate the association between blood NLR immediately prior to surgery and recurrence free and overall survival in breast cancer patients.
Methods
We performed a single institution, retrospective cohort study including all patients treated for invasive breast cancer amenable to primary surgery at our institution between 1st January 2006 and 31st December 2010. Clinical and pathologic details were collected from the patient medical records. Exclusion criteria included prior malignancy, chemotherapy receipt prior to surgery, recent corticosteroid use, systemic autoimmune conditions, recent significant cardiovascular illness, infection or inflammatory condition. NLR was calculated on the most recent complete blood count performed on the day of surgery or at the pre-surgical assessment. Eligible patients were divided into high (≥4) and low (&lt;4) NLR groups.
Results
We identified 357 patients, of whom 223 met eligibility criteria for analysis. At a median follow-up of 55.8 months, 18 patients (8.1%) died and 32 (14.3%) experienced disease recurrence. Kaplan Meier survival curves revealed significantly inferior overall survival (log-rank p=0.003) and recurrence free survival (log-rank p=0.01) in the high NLR group. Univariate Cox proportional hazard regression demonstrated an increased risk of mortality and breast cancer recurrence with pre-treatment NLR≥4, with hazard ratios of 5.49 (p=0.008, 95% CI 1.56 to 19.37) and 3.68 (p=0.016, 95% CI 1.28 to 10.58) respectively.
Conclusion
This study confirms pre-treatment NLR as a prognostic factor for breast recurrence and death among patients receiving curative surgery for early breast cancer. Strict inclusion criteria reduced the likelihood of confounding due to comorbidities which might affect NLR and be independently associated with poor outcomes. Our study supports the usefulness of NLR as a component of the prognostic assessment of early breast cancer patients.
Citation Format: Derbrenn O Connor, Mark L Griffin, Jenna S O'Sullivan, Sean Millar, Jo O'Keeffe, Brian R Bird, Sandra Deady, Conleth G Murphy. Pre-surgical neutrophil-to-lymphocyte ratio (NLR) is a prognostic indicator of recurrence free and overall survival in breast cancer patients undergoing primary surgery [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-35.