title: Immediate postoperative inflammation is an important prognostic factor in breast cancer.
abstract: OBJECTIVE
  Inflammation is associated with worse outcomes in cancer. Operations induce an acute inflammatory response and could impact the clinical outcomes in breast cancer. The neutrophil-lymphocyte ratio (NLR) is a well-known indicator of inflammation. We investigated the prognostic significance of perioperative inflammation with the NLR in breast cancer.
  
  
  METHODS
  We reviewed the clinical and pathological records of women diagnosed with invasive breast carcinoma at the Samsung Medical Center between 2000 and 2010. The NLR levels in the immediate preoperative period and the postoperative periods (1 week and 1 month) were assessed.
  
  
  RESULTS
  The NLRs of a total of 3,116 breast cancer patients were examined. In the univariate analysis, the NLR in postoperative week 1, total mastectomy, the presence of lymphovascular invasion, a higher nuclear grade and pathologic TNM stage, and negative hormone receptor and subtypes were factors associated with poor disease-specific survival. The NLR in postoperative week 1 remained a significant prognostic factor in the multivariate analysis. A cutoff level of 5.2, determined by the minimum p value approach, was found to be a significant level for discriminating the impact on breast cancer-specific mortality (p = 0.0116 adjusted by the Bonferroni correction).
  
  
  CONCLUSIONS
  Immediate postoperative inflammation is an important prognostic marker in breast cancer patients.
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Se Kyung
authors.initials: SK
authors.lastname: Lee
authors.forename: Min-Young
authors.initials: MY
authors.lastname: Choi
authors.forename: Soo Youn
authors.initials: SY
authors.lastname: Bae
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyun-Chul
authors.initials: HC
authors.lastname: Lee
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kil
authors.forename: Jeong Eon
authors.initials: JE
authors.lastname: Lee
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009504:Neutrophils / Q000378:metabolism*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult