The Relationship between Pre-Operative Biomarkers of Inflammation, Clinicopathological Characteristics and Cancer Specific Survival in Early Breast Cancer.

Abstract

Abstract Breast cancer is the second most common malignancy in women. Established prognostic factors include tumour size, grade, nodal involvement, and hormonal receptor status. Recently, the systemic inflammatory response (as evidenced by elevated C-reactive protein and low serum albumin) has been established as an independent predictor of survival in patients with metastatic breast cancer (1). However, the relationship between these systemic inflammatory markers, clinicopathological characteristics and cancer specific survival has not been established in early breast cancer.During the period June 2001 to May 2008, patients with early breast cancer presenting to two hospitals in the West of Scotland were prospectively included into this study (n=959). Preoperative C-reactive protein, albumin and clinico-pathological data were recorded for each patient. The thresholds for normal C-reactive protein and albumin were taken as <6 mg/l and >43g/l respectively.The median follow-up of the survivors was 4.1yrs. During this period, 93 patients died of their cancer. On multivariate analysis, tumour size (HR 2.03; 95%CI 1.41-2.91, P<0.001), lymph node status (HR 2.23; 95%CI 1.45-3.41, P<0.001), hormone receptor status (HR 1.58; 95%CI 1.24-2.00, P<0.001) and albumin <43g/l (HR 1.97; 95%CI 1.28-3.01, P=0.002) were significant independent predictors of cancer-specific survival. Lower serum albumin concentrations (<43g/l) were associated with deprivation (P=0.019) and significantly poorer 5-year cancer-specific survival (85 vs 92% P=0.005).The results of the present study show that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict cancer-specific survival, independent of clinico-pathologic status in early breast cancer. Further, evaluation of the pre-operative systemic inflammatory response and outcome in patient subsets is warranted.1. Al Murri AM, Wilson C, Lannigan A, Doughty JC, Angerson WJ, McArdle CS, McMillan DC. Evaluation of the relationship between the systemic inflammatory response and cancer-specific survival in patients with primary operable breast cancer.Br J Cancer. 2007;96:891-5 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6033.