24P - CRP and granulocyte-to-lymphocyte ratio as predictors of breast cancer death in American non-institutionalized women

Date 08 May 2014
Event IMPAKT 2014
Session Welcome reception and Poster Walk
Topics Breast Cancer
Translational Research
Presenter Wahyu Wulaningsih
Citation Annals of Oncology (2014) 25 (suppl_1): i8-i16. 10.1093/annonc/mdu066
Authors W. Wulaningsih, L. Holmberg, M. Van Hemelrijck
  • Division Of Cancer Studies, King's College London, SE1 9RT - London/UK



Inflammation plays an important role in breast cancer development and progression. We aimed to investigate the association between serum inflammatory markers C-reactive protein (CRP), absolute granulocyte count (AGC) and granulocyte and granulocyte-to-lymphocyte (G/L) ratio in relation to breast cancer death in a population-based setting.


This study was based on the Third National Health and Nutrition Examination Survey (NHANES III) conducted during 1988-1994 and the linked mortality follow-up data through December 31, 2006. We selected 8,184 women aged 20 and older with baseline measurements of CRP, AGC and G/L ratio. Cox proportional hazards regression was used to assess CRP, AGC and G/L ratio in relation to risk of breast cancer death as well as death from all cancer and all causes, while taking into account age, race, and other risk factors for breast cancer.


During mean follow-up of 167 months, 59 women died from breast cancer. A positive association was found between log-transformed CRP, AGC and G/L ratio and risk of breast cancer death (HR 1.63 (95% CI; 1.00-2.67), 3.69 (1.15-11.87) and 3.21 (1.39-7.41) per unit increase in log CRP, AGC, and G/L ratio, respectively), although the association with AGC was not seen after adjustment for BMI. CRP, AGC and G/L ratio were also strongly linked to cardiovascular and all-cause mortality. No statistically significant trend was observed for all-cancer death. Stratification by overweight status showed a persistent association between CRP, G/L ratio and breast cancer death in women with BMI ≥ 25 kg/m2 (HR 1.77 (95%CI: 1.02-3.05) and 4.44 (1.29-15.27) for every increase in log CRP and G/L ratio, respectively).


CRP and G/L ratio are consistent predictors of breast cancer death, cardiovascular and all-cause mortality. Our findings imply that the biological mechanisms linking obesity and inflammation may be important in breast cancer risk stratification. Finally, future studies are needed to explore the role of these markers as simple prognostic tools in assessing breast cancer.


All authors have declared no conflicts of interest.