Abstract P5-01-27: The relation between local tumor infiltrated T cells (TILs) and neutrophil-to-lymphocyte ratio (NLR) of peripheral blood in patients with De novo Stage IV breast cancer

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Abstract Purpose: We investigated whether the relation of tumor infiltrated T cells and neutrophil-to-lymphocyte ratio (NLR) can be a novel predictive factor for the benefit of surgery for de novo stage IV breast cancer (DnIV BC) and if primary tumor resection (PTR)'s surgical advantage related to clinical outcomes, the surgery timing in responders to systemic therapy. Patients and Methods: We reviewed the cases of the DnIV BC patients who received systemic therapies and/or underwent PTR at our institution (Jan. 2004–Dec. 2022). Blood tests and NLR measurement were performed before and after each systematic therapy and/or surgery. The kinetics of peripheral blood lymph cell counts, NLR etc. were analyzed simultaneously. The immunopathological stain was performed using surgical specimens or biopsy samples by anti-CD3, -CD8, -CD163 and -CD25(Foxp3) antibodies. Results: Sixty patients had undergone PTR local surgery (Surgery group); 81 patients had not undergone surgical treatment (Non-surgery group). In both groups, systemic treatment was performed as chemotherapy (95%) and/or endocrine therapy (92.5%) (p<0.0001). The groups' respective median progression-free survival (PFS) durations were 88 and 30.3 months (p=0.004); their overall survival (OS) durations were 100.1 and 31.8 months (p=0.0002). The Surgery-group responders to systemic therapy lasting >8.1-months showed significantly longer OS (p=0.044). The PFS and OS were significantly associated with the use of postoperative systemic therapy (p=0.0012) and the NLR (p=0.018). A low NLR (≤3) was associated with significantly better prognoses (PFS and OS; p<0.0001). The immunopathological study of surgical specimens showed the CD3, CD8+ T lymphocyte infiltration has significant increase in patients with low NLR. In contrast, there was no significant difference of CD163+ macrophage and CD25+ lymphocytes. Conclusions: A longer effective duration of systemic therapy (>8.1 months) and a low pre-surgery NLR (≤3.0) could predict PTR's surgical advantage for DnIV BC. These variables may help guide decisions regarding the timing of surgery for DnIV BC. Citation Format: Rie Sugihara, Uhi Toh, Hidetaka Watanabe, Shuntaro Matsushima, Shuko Saku, Mina Okabe, Nobutaka Iwakuma, Yutaro Mihara, Fumihiko Fujita. The relation between local tumor infiltrated T cells (TILs) and neutrophil-to-lymphocyte ratio (NLR) of peripheral blood in patients with De novo Stage IV breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-01-27.

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