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Poster display

3332 - Prognostic significance of the derived neutrophil-lymphocyte ratio in non-metastatic breast cancer: An institutional analysis from a tertiary care center in India

Date

10 Oct 2016

Session

Poster display

Presenters

Chandan Das

Citation

Annals of Oncology (2016) 27 (6): 68-99. 10.1093/annonc/mdw365

Authors

C.K. Das1, A. Gogia2, S. Deo3, N.K. Shukla3, S. Mathur4, V. Sreenivas5, D. Sharma6

Author affiliations

  • 1 Medical Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 2 Medical Oncology, All India Institute of Medical Sciences, New Delhi/IN
  • 3 Surgical Oncology, Institute of Rotary cancer Institute(IRCH), All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 4 Pathology, All India Institute of Medical Sciences, New Delhi/IN
  • 5 Biostatistics, All India Institute of Medical Sciences, New Delhi/IN
  • 6 Radiation Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
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Abstract 3332

Background

The prognostic value of cancer-associated inflammatory response has been evaluated in various solid malignancies.Derived Neutrophil to lymphocyte ratio (dNLR) is easily accessible and simple prognostic parameter of systemic inflammation associated with breast cancer. Data regarding the dNLR in breast cancer are limited in India. We assessed dNLR as a prognostic marker in patients with non-metastatic breast cancer treated at a tertiary care institute in North India

Methods

We retrospectively evaluated the impact of baseline peripheral neutrophil and lymphocyte counts on survival, and investigated the correlation between inflammatory biomarkers and clinico-pathological factors in 497 consecutively treated non-metastatic breast cancer patients between 2011-2014.

Results

Baseline characeristics N = 497

Parameters Results
Age in years 47.7(23-85)
Presenting symptoms Lump > pain > ulcer > bleeding
Duration of symptoms in month 7.8 (1-72)
Stage I 18(4%), II 228(46%), III 251(50%)
Histology Ductal 485(97.5%),Lobular 7(1.5%),Metaplastic 5(1%)
Receptor Status ER + /PR + HER2- 209(42%), ER + /PR+ HER2 + ++ 85(17%), ER-PR-HER2 + ++ 71(14%), TNBC 132(27%)
Hemoglobin in gm% 11.42(7-16)
Total Leukocyte count in mm3 7369 (2450-21900)
Absolute Neutrophil Count in mm3 4506 (1100-19800)
Elevated dNLR 142(28.6%)
Neoadjuvant Therapy 115(27.5%)

Out of the 497 patients,with a median follow up of 33.5 months, the median disease free survival (DFS) was 33.1 months and 3-year estimated overall survival (OS) was 90%. Receiver operating curve (ROC) analysis showed a cutoff of 2 to be sensitive (60%) and specific (73.7%) with coefficient of 0.76. Pre-therapy high dNLR was independently associated with tendency to poor PFS (HR 0.7, 95%CI 0.4-1.04, p= 0.085) and reduced OS (HR of 3.8, 95% CI = 1.9–7.6, p< 0.001).On multivariate analysis, following factors were associated with inferior survival: elevated dNLR (HR 0.8,p = 0.049, 95% CI1.65-0.04), nodal disease(HR 0.09,p = 0.028, 95%CI 0.009-0.17), presenting duration >6 months (HR 0.04,p-0.014, 95%CI 0.008-0.72) and TNBC subgroups (HR1.5, p 

Conclusions

In patients with breast cancer, inflammatory biomarker like elevated dNLR is strongly associated with poor overall survival.It can be utilized as a readily available and reproducible prognostic factor for patients with non-metastatic breast cancer across subgroups and its integration into patient evaluation is relevant in resource limited countries like India.

Clinical trial identification

Not Available

Legal entity responsible for the study

Ethics Committee, All India Institute of Medical Science

Funding

All India Institute of Medical Science, New Delhi

Disclosure

All authors have declared no conflicts of interest.

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