Abstract P3-08-12: Prognostic relevance of neutrophil-to-lymphocyte ratio (NLR) in young women with breast cancer (BC)
Bibliographic record
Abstract
Abstract Background: Many studies suggest that a high NLR prior to systemic treatment is an adverse prognostic marker for BC but its role in women ≤ age 40 in general, and in those with pregnancy associated BC (PABC) in particular is unknown. We investigated whether the NLR is independently prognostic for recurrence-free survival (RFS) in a prospective database of young BC patients. Methods: A prospective database of women ≤40 years of age diagnosed with BC from 02-2008 to 01-2015 was analyzed. Data regarding age, stage at diagnosis, pathology, treatment and clinical outcomes were available; the NLR was abstracted from the patients' medical record retrospectively with all values obtained post-diagnosis and prior to systemic therapy. The Kaplan-Meier method was used to estimate time-to-event outcomes, with a primary outcome of RFS. Insufficient events had occurred to analyze overall survival. Univariable Cox proportional hazards regression models were used to evaluate factors that were potentially prognostic for RFS; a subsequent multivariable Cox proportional hazards model adjusted for nodal involvement, PABC status and tumor size. All tests were two-sided and statistical significance was defined as a p-value ≤0.05. Results: Of 233 women in the database, 208 had a NLR and outcomes available for analysis. The mean age of patients was 35.1 and 24% (n=66/233) had PABC (BC diagnosed during pregnancy or ≤ 24 months postpartum); the median size of their tumors was 2.8 cm (range 0.1 cm – 19.0 cm) and 48% (n=102/211) were node positive. The majority of women had hormone receptor positive (92%; n=206/223) and HER2 negative 75% (n=160/212) disease, 50% (n=112/223) were treated with breast conserving surgery, 61% (n=142/233) received adjuvant radiotherapy and 83% (n=184/223) received adjuvant chemotherapy. With a median follow-up of 41 months, 16 patients (7%) experienced a local recurrence and 25 (11%) had distant recurrent disease. A higher NLR was prognostic for an adverse RFS in both uni- and multi-variable models (Table). The neutrophil count, individually, was also prognostic for adverse RFS but the lymphocyte count was not. The findings for patients with PABC and non-PABC were similar (interaction tests >0.05). Prognostic association between NLR and RFSVariableNumber of patients (total N=223)Univariable HR (95% CI)P valueMultivariable HR (95% CI)P valueSize ( /cm)1981.1 (0.9 - 1.2)0.261.0 (0.5 - 1.9)0.99Node positive (yes vs no)2042.1 (0.9 - 4.8)0.0912.6 (1.0 - 6.7)0.050PABC (yes vs no)2232.2 (1.0 - 4.8)0.0481.8 (0.8 - 4.3)0.17Log[NLR] ( /unit)2082.6 (1.3 - 5.0)0.0062.5 (1.2 - 5.0)0.006Log[neutrophils] ( /unit)2082.9 (1.2 - 7.3)0.023--Log[lymphocytes] ( /unit)2080.54 (0.16 - 1.8)0.31-- Conclusions: A higher NLR is prognostic for adverse RFS in our cohort of women ≤40 years of age with BC, including those with PABC. In our study, a higher neutrophil count drives the prognostic effects of NLR, suggesting an inflammatory state. If our results are confirmed in larger data sets, these findings may warrant the investigation of anti-inflammatory agents in the treatment of young women with BC. As BC in this age group has a worse prognosis than BC in older women, the potential benefit of anti-inflammatory agents may be easier to observe in this population. Citation Format: Jerzak KJ, Zhu S, Nofech-Mozes S, Pond G, Warner E. Prognostic relevance of neutrophil-to-lymphocyte ratio (NLR) in young women with breast cancer (BC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-12.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".