Abstract 2990
Background
The presence of pretreatment lymphopenia or high NLR (neutrophil-lymphocyte ratio) has been reported as poor prognostic factor in breast cancer. Here, we investigated whether baseline lymphocyte counts and NLR are associated with overall survival (OS), breast cancer specific survival (BCSS), and distant recurrence free survival (DRFS) in large early breast cancer (EBC) patient cohort.
Methods
We reviewed demographic, clinical, pathologic, and survival data from Yonsei Breast Cancer Center Registry. Patients who underwent surgery with stage I-III EBC at the Yonsei Cancer Center between 2006 and 2015 were included. Baseline complete blood counts data were collected from electronic medical records system. Multivariable regression models adjusted for age, stage, neoadjuvant/adjuvant chemotherapy use, subtype were used to evaluate associations between baseline absolute lymphocyte count (ALC) and OS/BCSS/DRFS.
Results
A total of 5,785 stage I–III EBC patients were underwent breast surgery from 2006 to 2015; 533 patients were excluded due to lack of complete data (n = 262) and the diagnosis of second primary cancer (n = 270). Median follow up duration was 72.73 months (95% confidence interval (CI), 73.85-75.64). Of 5,252 eligible patients, only 159 (3.0%) had baseline lymphopenia (ALC < 1,000/mL). The incidence of baseline lymphopenia was similar among age group, stage, and subtype, but patients with HBsAg (+) showed higher baseline lymphopenia than HBV negative patients (7.7% vs. 2.9%, p = <0.001). In univariate analysis, baseline lymphopenia was significantly associated with poor OS, BCSS and DRFS. In multivariable analysis, baseline lymphopenia predicted lower DRFS [HR 0.502; 95% CI, 0.307–0.820]. The prognostic significance of baseline lymphopenia regarding to DRFS was highest in HER2 positive subtype.Table: 196P
Baseline demographics
| All Patients (n = 5,252) | Baseline Lymphopenia (n = 158) | No Baseline Lymphopenia (n = 5,094) | |
|---|---|---|---|
| Age | |||
| Median (Range) | 50 (19-92) | 48 (31-77) | 50 (19-92) |
| TNM Stage | |||
| I | 2672 (50.9) | 81 (51.3) | 2591 (50.9) |
| II | 1890 (36) | 53 (33.5) | 1837 (36.1) |
| III | 450 (8.6) | 18 (11.4) | 432 (8.5) |
| Subtype | |||
| ER+/HER2- | 3286 (62.6) | 90 (57) | 3196 (62.7) |
| ER+/HER2+ | 558 (10.6 | 19 (12) | 539 (10.6) |
| ER-/HER2+ | 496 (9.4) | 22 (13.9) | 474 (9.3) |
| ER-/HER2- | 912 (17.4) | 27 (17.1) | 885 (17.4) |
| Neoadjuvant chemotherapy | |||
| Yes | 983 (18.7) | 124 (78.5) | 4145 (81.4) |
| No | 4269 (81.3) | 34 (21.5) | 949 (18.6) |
| Adjuvant chemotherapy | |||
| Yes | 2957 (56.3) | 69 (43.7) | 2226 (43.7) |
| No | 2295 (43.7) | 89 (56.3) | 2868 (56.3) |
| Radiation therapy | |||
| Yes | 3755 (71.5) | 49 (31) | 1448 (28.4) |
| No | 1497 (28.5) | 109 (69) | 3646 (71.6) |
| Endocrine therapy | |||
| Yes | 3799 (72.3) | 108 (68.4) | 3691 (72.5) |
| No | 1453 (27.7) | 50 (31.6) | 1403 (27.5) |
| HBsAg test | |||
| Positive | 182 (3.5) | 14 (8.9) | 168 (3.3) |
| Negative | 4419 (84.1) | 126 (79.7) | 4293 (84.3) |
| Unknown | 651 (12.4) | 18 (11.4) | 633 (12.4) |
| Baseline Lymphopenia | |||
| Yes | 158 (3) | ||
| No | 5094 (97) |
Conclusions
Baseline lymphocyte counts predicted distant recurrence in early breast cancer.
Clinical trial identification
Legal entity responsible for the study
Gun Min Kim.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.