Abstract P6-08-32: Elevated neutrophil lymphocyte ratio predicts survival in breast cancer
Authors: Koh Cher Hui , Bhoo-Pathy Nirmala , Ng Khoon Leong , See Mee Hoong , Tan Gie Hooi , Jamaris Suniza , Taib Nur Aishah 
Published: May 2015

Abstract
Background: Host inflammatory response affects disease progression and survival in cancer. While the elevation of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated with poor prognosis in colorectal cancer, evidence on prognostic significance of these indicators in breast cancer is sparse. We determined whether the initial, pretreatment NLR and PLR impact survival of patients presenting with primary breast cancer.
Methods: Of 2059 consecutive patients, newly diagnosed with breast cancer in University Malaya Medical Centre, Malaysia between January 2000 and December 2008, we only included 1447 patients with available differential blood count at time of diagnosis (∼70%). Data on tumor characteristics and treatment were obtained from the hospital-based breast cancer registry whereas vital status was verified with the national mortality registry. Patients were stratified into quintiles of NLR and PLR. Differences in demography, tumor characteristics and treatment patterns between the quintiles were assessed. Relative survival rates (RSR) were estimated using the Malaysian population mortality data. Multivariable Cox regression was used to determine the independent prognostic significance of NLR and PLR.
Results: Median age at presentation was 52 years, whereas median tumor size at diagnosis was 3.5 cm with 48% of patients presenting with axillary lymph node involvement. Both NLR and PLR were positively correlated (p&lt;0.001). Compared to patients in the lowest NLR quintile (NLR≤1.38), those in the highest quintile (NLR ≥3.95) were younger at diagnosis (median: 49 years versus 56 years; p&lt;0.001), and presented with bigger tumors (median: 5.0 cm versus 3.0 cm: p&lt;0.001), axillary lymph node metastasis (55.2% versus 45.9%; p=0.035), distant metastases at diagnosis (32.0% versus 7.2%: p&lt;0.001), and higher tumor grades (49.6% versus 33.9%: p=0.016). A total of 598 deaths were observed during 9248 person-years of follow-up, corresponding with a 5-year RSR of 70.3% (95%CI: 67.7%-72.8%). Higher NLR quintiles were significantly associated with poorer survival; 5-year RSRs were 75.6% (95%CI: 68.9%-81.4%) in quintile 1, 79.4% (95%CI: 74.5%-83.7%) in quintile 2, 72.3% (95%CI: 66.5%-77.5%) in quintile 3, 65.5% (95%CI: 59.7%-70.9%) in quintile 4, and 51.8% (95%CI: 44.4%-58.7%) in quintile 5. Following adjustment for age, ethnicity, AJCC6 stage, PLR, tumor grade, lymphovascular invasion, hormonal receptor status, locoregional management, chemotherapy, and hormone therapy, the hazard ratios (HR) for the second to fifth quintiles of NLR compared to the first quintile were 1.06 (95%CI:0.80–1.40), 1.15 (95%CI:0.86–1.55), 1.59 (95%CI:1.21–2.10), and 2.42 (95%CI:1.81–3.21) respectively; p for linear trend test &lt;0.001. Patients in the highest PLR quintile were also significantly associated with decreased survival compared to those in the lowest quintile; 5-RSR: 53.2% (95%CI: 46.9%-59.1%) versus 76.9% (95%CI: 70.9%-82.1%), respectively. Nevertheless, this association was not significant following multivariable adjustment (HR: 0.99, 95%CI:0.76-1.29).
Conclusion: High NLR seems to be an independent prognostic factor for breast cancer but not PLR. These findings warrant further validation.
Citation Format: Cher Hui Koh, Nirmala Bhoo-Pathy, Khoon Leong Ng, Mee Hoong See, Gie Hooi Tan, Suniza Jamaris, Nur Aishah Taib. Elevated neutrophil lymphocyte ratio predicts survival in breast cancer [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 P6-08-32.