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The significance of the inter-relationship between tumour and host local/systemic inflammatory responses in primary operable invasive breast cancer is limited. The inter-relationship between the systemic inflammatory response (pre-operative white cell count, C-reactive protein and albumin concentrations), standard clinicopathological factors, tumour T-lymphocytic (CD4 þ and CD8 þ ) and macrophage (CD68 þ ) infiltration, proliferative (Ki-67) index and microvessel density (CD34 þ ) was examined using immunohistochemistry and slide-counting techniques, and their prognostic values were examined in 168 patients with potentially curative resection of early-stage invasive breast cancer. Increased tumour grade and proliferative activity were associated with greater tumour T-lymphocyte (Po0.05) and macrophage (Po0.05) infiltration and microvessel density (Po0.01). The median follow-up of survivors was 72 months. During this period, 31 patients died; 18 died of their cancer. On univariate analysis, increased lymph-node involvement (Po0.01), negative hormonal receptor (Po0.10), lower albumin concentrations (Po0.01), increased tumour proliferation (Po0.05), increased tumour microvessel density (Po0.05), the extent of locoregional control (Po0.0001) and limited systemic treatment (Pp0.01) were associated with cancer-specific survival. On multivariate analysis of these significant covariates, albumin (HR 4.77, 95% CI 1.35 -16.85, P ¼ 0.015), locoregional treatment (HR 3.64, 95% CI 1.04 -12.72, P ¼ 0.043) and systemic treatment (HR 2.29, 95% CI 1.23 -4.27, P ¼ 0.009) were significant independent predictors of cancer-specific survival. Among tumour-based inflammatory factors, only tumour microvessel density (Po0.05) was independently associated with poorer cancerspecific survival. The host inflammatory responses are closely associated with poor tumour differentiation, proliferation and malignant disease progression in breast cancer.

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The relationship between the systemic inflammatory response (as evidenced by elevated C-reactive protein and lowered albumin concentrations), clinico-pathologic status and relapse-free, cancer-specific and overall survival was examined in patients with invasive primary operable breast cancer (n ¼ 300). The median follow-up of the survivors was 46 months. During this period, 37 patients relapsed and 25 died of their cancer. On multivariate analysis, only tumour size (Po0.05), albumin (Po0.01) and systemic treatment (Po0.0001) were significant independent predictors of relapse-free, cancer-specific and overall survival. Lower serum albumin concentrations (p43 g l À1 ) were associated with deprivation (Po0.05), hormonal receptor negative tumours (Po0.01) and significantly poorer 3-year relapse-free (85 vs 93%, P ¼ 0.001) cancer-specific (87 vs 97%, Po0.0001) and overall survival (84 vs 94%, P ¼ 0.001) rates. The results of the present study suggest that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict relapse-free, cancer-specific and overall survival, independent of clinico-pathologic status and treatment in patients undergoing potentially curative surgery for primary operable breast cancer.