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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 teacher head, 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".