Abstract P4-06-05: Can we adapt neoadjuvant rectal (NAR) score besides sytemic immun inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors to locally advanced breast cancer?
Authors: Yüksel Cemil , Doğan Mutlu , Çulcu Serdar , Doğan Lütfi 
Published: March 2022

Abstract
Introduction. Neoadjuvant treatment (NAT) is standard in locally advanced breast (LABC) & rectal cancer (LARC). Neoadjuvant rectal (NAR) score is a novel prognostic factor in LARC. Therefore, NAR score may also have prognostic value in LABC. We aimed to adapt NAR score with inflammatory indices such as systemic immune inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors in LABC. Material and Methods. 187 LABC patients who had NAT at our center were evaluated retrospectively. The nomogram by Valentini for NAR score was used. Cutoff values for NAR, SII & PNI were defined by ROC analysis. NAR score cut off value was 28.35 with 62.5% sensitivity and 65.4% specificity. Patients were grouped as NAR score low (NAR-L, ≤ 28.35) & high (NAR-H, &gt;28.35) subgroups. Inflammatory indices such as SII (neutrophil (109/L)×platelet (109/L))/lymphocyte (109/L) & PNI (albumin (g/L) + 5× lymphocyte (109/L) were calculated before (bNAT) & after (aNAT) NAT. Cut off values for bNAT & aNAT were as defined as 656 & 687 for SII and 42.5 & 40.5 for PNI. Correlation among pathological features, sentinel lymph node (SLN) & axillary lymph node (ALN) positivity rates and NAR score was evaluated. We also evaluated prognostic significance of SII & PNI. Results. Median follow up was 22 (3-109) months. All patients were female with a median age as 54 (27-79) years. While 116 (62%) patients were in NAR-L group, 71 (38%) were in NAR-H group. Median age was 54 (31-79) years for NAR-L, 54 (27-79) years for NAR-H subgroups. NAR-H group had higher mortality & relaps rates (p=0.009, p=0.009). Patients in NAR-H group had. lower pathological complete response (pCR), more lymphovascular invasion (LVI), perineural invasion (PnI) and higher postoperative ALN (&gt;0.19) positivity rate (p&lt; 0.001, p&lt; 0.001, p&lt; 0.001, p&lt; 0.001) (Table 1). Lower PNI aNAT (&lt;40.5) was a significant poor prognostic factor (p=0.027). Perineural invasion was higher in patients with higher SII bNAT (p=0.027). PNI aNAT was negatively correlated with postoperative ALN positivity rate & mortality (p=0.033, p=0.027). There was a significant decrease in PNI & increase in SII with NAT (p=0.001, p=0.012). Discussion. We consider that NAR score & PNI aNAT can be adapted to LABC as prognostic factors. Patients with higher NAR score (&gt;28.35) & lower PNI aNAT (&lt;40.5) had higher mortality rate. NAR-H group had poorer pathological features & higher SII bNAT group had more PnI. NAT led to significant changes in PNI & SII. Randomized clinical trials are needed in this area.
Relationship between NAR score & pathological featuresn (%)pNAR-L (≤ 28.35)NAR-H (&gt;28.35)Mortality40 (17.9)26 (11.0)0.009Relaps7 (6.1)16 (22.5)0.001PCR43(37.1)3(4.2)&lt;0.001LVI35 (30.2)45 (63.4)&lt;0.001PnI26 (22.4)39 (54.9)&lt;0.001SLN21 (31.3)20 (90.9)&lt;0.001ALN17 (23.3)59 (83.1)&lt;0.001
Citation Format: Cemil Yüksel, Mutlu Doğan, Serdar Çulcu, Lütfi Doğan. Can we adapt neoadjuvant rectal (NAR) score besides sytemic immun inflammation index (SII) and prognostic nutritional index (PNI) as prognostic factors to locally advanced breast cancer? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-06-05.