Abstract 264P
Background
Neutrophil-to-lymphocyte ratio (NLR) reflects the immune and inflammatory system responses to tumors. However, retrospective trials have shown conflicting results on the prognostic role of NLR for neoadjuvant chemotherapy (NAC). We aimed to evaluate this role in patients with locally advanced breast cancer by evaluating the association of NLR with complete pathological responses (pCR) in the axilla and breast.
Methods
The records of patients who received NAC at our cancer center between January 2005 and December 2014 were obtained from a prospective breast cancer database and reviewed. Patients’ disease characteristics were presented as medians and frequencies for continuous and categorical variables, respectively. Univariate and multivariate analyses of pCR were performed using a logistic regression model. The association between NLR and pCR among breast cancer subtypes was evaluated using Pearson’s chi-square test. Disease-free (DFS) and overall (OS) survival rates were calculated using the Kaplan-Meier estimator and compared using log-rank analysis.
Results
In total, 465 patients (median age of 44 years at diagnosis) were eligible for the study. Of the patients, 66.4% had T2 or T3, 33.2% had T4 non-inflammatory, 71% had N1, and 22.7% had N2 disease. A complete response was attained in 118 patients (25%). The pCR rate among each molecular subtypes was as follows: ER+/Her2-ve, 9.6%; ER+/Her2+ve, 33.7%; ER-ve/Her2+ve, 43%; and triple-negative, 35.2%. The patients were stratified into low (62.4%) and high (37.6 %) NLR groups according to the best cutoff NLR of 2.2 from the receiver-operating characteristic curve. Multivariate analysis revealed a significant association between NLR and pCR. The low NLR group had a higher probability of achieving pCR (odds ratio: 2.6, 95% confidence interval [CI]: 1.5–4.3, P<0.001, consistent among all subtypes [P=0.41]), a higher median DFS (14 years vs. 12.5 years, P=0.02), and a higher 5-year OS (90% vs. 82%, P=0.04) than the high NLR group.
Conclusions
NLR is a promising independent prognostic tool for NAC pathological response in all four molecular subtypes. Further, it can be a prognostic factor for DFS and OS in locally advanced breast cancer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.