الفهرس 
INTRODUCTION AND RATIONALEOnly 14 pages are availabe for public view
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Abstract
Inflammation has strong association with progression of tumours. Developing of most cancers starts as chronic inflammation or irritation. Several recent studies highlight the importance of peripheral blood inflammatory cells. Neutrophils, lymphocytes, platelets and their ratios to each other can be used as prognostic factors in many malignant tumours. Many studies show that high neutrophil lymphocyte ratio (NLR) is associated with poor prognosis in advanced non-small cell lung cancer, renal cell cancer, gastric cancer and metastatic melanoma; While, high platelets lymphocyte ratio (PLR) has been reported to be associated with poor prognosis in oesophageal cancer, epithelial ovarian cancer and lung cancer. Lymphocytes have an important role in cancer immunosurveillance and have been associated with prognosis in many cancers including breast cancer. Neutrophils produce cytokines associated with tumour progression and suppress cytolytic activity of lymphocytes resulting in further angiogenesis and tumour progression. Platelets may produce some growth factors as plate¬let derived growth factor (PDGF), platelet factor 4 (PF4) and thrombospondin and these factors are involved in the progression of tumour spread and progression.
This retrospective cross sectional analytic study was held in Suez Canal university hospitals, Ismailia, Egypt, department of clinical oncology and nuclear medicine over 105 histo-pathologically proven non-metastatic breast cancer patients who received adjuvant chemotherapy, data was collected from medical records during the period from 1/2015 to 12/2016 with follow up period 5 years.
In the current study, the mean age of the patients was 47.82 ± 11.65 years with range between 25 and 78 years, only 34.3% had at least a history of one chronic illness. The most common co-morbidities were hypertension (20%) and diabetes (15.2%). About 90% of the patients had invasive ductal carcinoma histological type and grading type II. About 22% of the patients had multicentric tumour. About two thirds of the patients had luminal receptors, while about 23% had Her2 enriched receptors and about 16% had triple negative receptors. more than 85% of the patients had modified radical mastectomy. Almost all patients had chemotherapy and radiotherapy and about two thirds of them had hormonal therapy. Only 11.4% of the patients had target therapy. 32.4% of the patients had recurrence. Distant metastasis was the commonest pattern of metastasis among our sample. Cut off point was 1.55 for NLR and 106.5 for PLR for all over survival. high NLR forms 53.3% of the total sample with mean value 1.86 ± 0.97. Similarly, patients with high PLR represent 55.2% of the total sample with mean value 137.84 ± 76.36. There was no statistically significant difference between patients with low NLR and high NLR in regard to patients’ demographic characteristics and patients’ treatment characteristics. High PLR was significantly associated with higher nodal involvement (p=0.019) and higher staging (p=0.022). There was no statistically significant difference in the overall patient survival between patients with low NLR and high NLR (Plogrank = 0.236) and patients with low PLR and high PLR (Plogrank = 0.194). Cut off point was 1.65 for NLR and 112 for PLR for disease free survival. There was no statistically significant difference in the disease-free survival between patients with low NLR and high NLR (Plogrank = 0.357) and patients with low PLR and high PLR (Plogrank = 0.866). There was no statistically significant difference in the overall patient survival and disease-free survival between patients with low NLR and PLR and high NLR and PLR (Plogrank = 0.102).