Abstract P6-08-48: Neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive prognostic markers for the metastatic breast cancer (MBC)
Authors: Miyamoto Takeshi , Fujisawa Tomomi , Morishita Akiko , Yanagita Yasuhiro 
Published: May 2015

Abstract
Introduction: The possibility of tumor infiltlating lymphocytes as a predictive marker of the neoadjuvant chemotherapy for breast cancer was discussed at SABCS 2013. 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 macro inflammatory environment as an extension of the microenvironment, the neutrophil / lymphocyte ratio (NLR) is a useful method and a simple indicator of systemic inflammatory state. We have some reports that NLR can predict the prognosis in gastric cancer and colorectal cancer. But in breast cancer, few reports can be seen. We examined the relationship of NLR and the risk of recurrence in curable breast cancer in our hospital, and could not detect the specific relations. We hypothesized one of the reasons that resectable breast cancers are not in systemic phase in the view of inflammatory or immune reaction. Therefore, the next, in metastatic breast cancer (MBC), absolutely systemic disease, we tried to reveal the relationship of the NLR at the recurrence and the prognosis.
Purpose: To evaluate the NLR affects the Overall Survival (OS) of the patients of MBC or not.
Patients: From 2003 to 2013, we have 300 MBC patients in our hospital included 53 Stage4 patients at the first visit. Median Disease free survival (DFS) is 911-day, the median OS after the recurrence is 1196-day. Average value of the NLR is 2.85. The reasons of MBC are bone metastases, pleural and pulmonary metastases, liver metastasis, lymph node metastasis, central nervous system (CNS) metastasis, unresectable metastatic chest wall recurrence, or other.
Result: By univariate analysis, NLR ≥3.7(p&lt;0.01), DFS &gt;1000 days, (p&lt;0.01), liver metastases, (p&lt;0.05), CNS metastasis (p&lt;0.01), and 2 or more organs metastasis (p&lt;0.05) made a contribution to poor OS. Between these 5 factors, special relations were not seen. Other factors, stage4, organ metastasis except for liver and CNS, tumor subtype and the age at recurrence had no significant effects for OS. Out of these 5, not only DFS &gt;1000(p&lt;0.01) or CNS metastasis (p&lt;0.01) but also NLR ≥3.7 (p&lt;0.05) were the independent prognostic factors by using multivariate analysis.
Discussion: The NLR was one of the prognostic factors which we can easily and simply examine by blood sample. The reason of this fact, we suggest, is that the whole body micro-environment caused by the immune or inflammatory cells at MBC occurred contributes to tumor growth. For hormone receptor positive MBC without life threading organ metastasis, we select hormonal therapy first, usually. But, high NLR MBC patient have a possibility of selection for up-front chemotherapy even if without life threading metastasis. High Ki67-index as well as high NLR may be useful for the prognostic biomarker, however, make no decision for the chemotherapy agents. First, we need to accumulate further retrospective cases and plan the prospective study to make sure of the adequate treatment divided by NLR.
Conclusion: The NLR ≥3.7 is one of the independent predictive prognostic factors for MBC as well as DFS &gt;1000 days and CNS metastasis.
Citation Format: Takeshi Miyamoto, Tomomi Fujisawa, Akiko Morishita, Yasuhiro Yanagita. Neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive prognostic markers for the metastatic breast cancer (MBC) [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 P6-08-48.