title: Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy.
abstract: BACKGROUND
  The primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST.
  
  
  METHODS
  247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival.
  
  
  RESULTS
  PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed.
  
  
  CONCLUSIONS
  Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. christoph.suppan@klinikum-graz.at.
authors.forename: Christoph
authors.initials: C
authors.lastname: Suppan
authors.affiliation: Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria. vesna.bjelic-radisic@medunigraz.at.
authors.forename: Vesna
authors.initials: V
authors.lastname: Bjelic-Radisic
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. marlen.lagarde@medunigraz.at.|Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria. marlen.lagarde@medunigraz.at.
authors.forename: Marlen
authors.initials: M
authors.lastname: La Garde
authors.affiliation: Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria. andrea.strele@klinikum-graz.at.
authors.forename: Andrea
authors.initials: A
authors.lastname: Groselj-Strele
authors.affiliation: Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria. katharina.eberhard@medunigraz.at.
authors.forename: Katharina
authors.initials: K
authors.lastname: Eberhard
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. hellmut.samonigg@medunigraz.at.
authors.forename: Hellmut
authors.initials: H
authors.lastname: Samonigg
authors.affiliation: Apeiron Biologics AG, Campus-Vienna-Biocenter 5, 1030, Vienna, Austria. hans.loibner@apeiron-biologics.com.
authors.forename: Hans
authors.initials: H
authors.lastname: Loibner
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. nadia.dandachi@medunigraz.at.
authors.forename: Nadia
authors.initials: N
authors.lastname: Dandachi
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. marija.balic@medunigraz.at.
authors.forename: Marija
authors.initials: M
authors.lastname: Balic
mesh_terms: D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome