Fax +49 761 4 52 07 14 Information@Karger.com www.karger.com Accessible online at: www.karger.com/ort Original Article Oncol Res Treat 2015;38:24–27 DOI: 10.1159/000370341 The Preoperative Neutrophil/Lymphocyte Ratio Does not Correlate with the 21-Gene Recurrence Score in Estrogen Receptor-Positive Breast Cancer Patients Tal Grenader a, b Yevgeni Plotkin c David B. Geffen c, d a Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel; b University College London, United Kingdom; c Soroka University Medical Center, Beer Sheva, Israel; d Ben-Gurion University of the Negev, Beer Sheva, Israel Introduction Breast cancer (BC) is the most prevalent malignancy worldwide and the second leading cause of cancer-related death among women. Roughly 75% of these tumors are hormone receptor (HR) positive. In patients with estrogen receptor (ER)-positive, early- stage BC, the 21-gene recurrence score (RS) assay (OncotypeDX TM ; Genomic Health Inc., Redwood City, CA, USA) is widely employed to help determine appropriate candidates for adjuvant chemother- apy [1]. The RS ranges from 0 to 100 and constitutes a measure of the risk of distant relapse within 10 years for patients with ER-positive, node-negative BC, treated with adjuvant tamoxifen. It also predicts the individualized benefit of hormonal therapy and chemotherapy [1]. Currently, evidence suggests that the RS is prognostic for pa- tients with ER-positive BC with node-positive disease as well [2]. This test is relevant in nearly half of all newly diagnosed BC pa- tients. Therefore, its wide use can represent significant costs to healthcare systems, considering that most of the patients have early-stage and ER-positive BC. The importance of systemic inflammation in promoting car- cinogenesis and tumor progression is well recognized. Inflamma- tion in the tumor microenvironment plays an important role in the proliferation and survival of malignant cells and was found to modulate tumor function, with both anti- and pro-tumor effects, in many solid tumors. Recent data suggest that systemic inflamma- tion contributes to the development and progression of BC. In- flamed adipose tissue within the breast is associated with elevated levels of pro-inflammatory mediators, enhanced expression of aro- matase (the rate-limiting enzyme for estrogen biosynthesis), and increased ER-α-dependent gene expression [3]. Numerous studies have established that elevated inflammatory markers, such as C- Keywords Breast cancer · Estrogen receptor · Gene assay · Neutrophil/lymphocyte ratio · OncotypeDX TM · Recurrence score Summary Aims: The aim of this study was to examine the correla- tion, if any, between the preoperative neutrophil/lym- phocyte ratio (NLR) and the OncotypeDX TM 21-gene re- currence score (RS) in patients with early-stage estrogen receptor (ER)-positive breast cancer (BC). Materials and Methods: We retrospectively reviewed the medical re- cords of patients diagnosed with primary ER-positive BC who were referred for the RS assay. The correlation be- tween the preoperative NLR and the RS was analyzed. Results: For the 242 patients with sufficient data for anal- ysis, the median age at diagnosis was 59.5 years. The tumor size ranged from 0.50 to 5.50 cm, with a mean size of 1.8 cm; 73.2% of the tumors were < 2 cm in size. Most of the tumors (66.3%) were of grade 2; the rest was nearly equally divided between grades 1 and 3. The test results for the progesterone receptor (PR) were positive in 86.6% of the cases. Lymph node metastases were pre- sent in 22.3% of the patients. The median RS was 18 (range 0–60) and the mean NLR value was 2.11 (range 0.49–7.49). We found no significant correlation between the NLR and the RS. Conclusion: Our data suggest that the preoperative NLR does not predict the 21-gene RS in patients with early-stage hormone-sensitive BC. Received: June 12, 2014 Accepted: November 19, 2014 Published online: January 12, 2015 Tal Grenader, MD Department of Oncology Shaare Zedek Medical Center P.O. Box 3235, 91031 Jerusalem, Israel talgrenader65@hotmail.com © 2015 S. Karger GmbH, Freiburg 2296-5270/15/0381-0024$39.50/0 Downloaded by: 54.70.40.11 - 11/20/2017 2:50:44 AM