Pre-treatment systemic immune-inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy

Li Chen, Xiangyi Kong, Zhongzhao Wang, Xiangyu Wang, Yi Fang, Jing Wang, Li Chen, Xiangyi Kong, Zhongzhao Wang, Xiangyu Wang, Yi Fang, Jing Wang

Abstract

The systemic immune-inflammation index (SII = N × P/L) based on neutrophil (N), platelet (P) and lymphocyte (L) counts is used to predict the survival of patients with malignant tumours and can fully reflect the balance between host inflammatory and immune status. This study is conducted to explore the potential prognostic significance of SII in patients with breast cancer undergoing neoadjuvant chemotherapy (NACT). A total of 262 patients with breast cancer received NACT were enrolled in this study. According to the receiver operating characteristic curve, the optimal cut-off value of SII was divided into two groups: low SII group (<602 × 109 /L) and high SII group (≥602 × 109 /L). The associations between breast cancer and clinicopathological variables by SII were determined by chi-squared test or Fisher's exact test. The Kaplan-Meier plots and log-rank test were used to determine clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of SII was analysed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by National Cancer Institute Common Toxicity Criteria (NCICTC). According to univariate and multivariate Cox regression survival analyses, the results showed that the value of SII had prognostic significance for DFS and OS. The patients with low SII value had longer DFS and OS than those with high SII value (31.11 vs 40.76 months, HR: 1.075, 95% CI: 0.718-1.610, P = .006; 44.47 vs 53.68 months, HR: 1.051, 95% CI: 0.707-1.564, P = .005, respectively). The incidence of DFS and OS in breast cancer patients with low SII value was higher than that in those patients with high SII value in 3-, 5- and 10-year rates. The common toxicities after NACT were haematological and gastrointestinal reaction, and there were no differences by SII for the assessment of side effects of neoadjuvant chemotherapy. Meanwhile, the results also proved that breast cancer patients with low SII value and high Miller and Payne grade (MPG) survived longer than those breast cancer with high SII value and low MPG grade. In patients without lymph vessel invasion, these breast cancer patients with low SII value had better prognosis and lower recurrence rates than those with high SII value. Pre-treatment SII with the advantage of reproducible, convenient and non-invasive was a useful prognostic indicator for breast cancer patients undergoing neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

Keywords: breast cancer; neoadjuvant chemotherapy; prognosis; survival; systemic immune-inflammation index (SII).

Conflict of interest statement

The authors declare no competing financial interests.

© 2020 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
DFS and OS of patients with breast cancer. A, Kaplan‐Meier analysis of DFS of all patients with breast cancer. B, Kaplan‐Meier analysis of OS of all patients with breast cancer. C, Kaplan‐Meier analysis of DFS for the SII of all patients with breast cancer. D, Kaplan‐Meier analysis of OS for the SII of all patients with breast cancer. SII is a novel systemic immune‐inflammation index (SII = N×P/L), which is based on neutrophil (N), platelet (P) and lymphocyte (L) counts
Figure 2
Figure 2
The 3‐, 5‐ and 10‐year rates of DFS and OS in patients with breast cancer. A, The 3‐, 5‐ and 10‐year rates of DFS in all patients with breast cancer. B, The 3‐, 5‐ and 10‐year rates of OS in all patients with breast cancer. C, The 3‐, 5‐ and 10‐year rates of DFS in all patients by SII with breast cancer. D, The 3‐, 5‐ and 10‐year rates of OS in all patients by SII with breast cancer
Figure 3
Figure 3
DFS and OS of patients for the SII by molecular subtypes with breast cancer. A, Kaplan‐Meier analysis of DFS of patients by Luminal A subtype with breast cancer. B, Kaplan‐Meier analysis of OS of patients by Luminal A subtype with breast cancer. C, Kaplan‐Meier analysis of DFS of patients by Luminal B HER2‐positive subtype with breast cancer. D, Kaplan‐Meier analysis of OS of patients by Luminal B HER2‐positive subtype with breast cancer. E, Kaplan‐Meier analysis of DFS of patients by Luminal B HER2‐negative subtype with breast cancer. F, Kaplan‐Meier analysis of OS of patients by Luminal B HER2‐negative subtype with breast cancer. G, Kaplan‐Meier analysis of DFS of patients by HER2‐enriched subtype with breast cancer. H, Kaplan‐Meier analysis of OS of patients by HER2‐enriched subtype with breast cancer. I, Kaplan‐Meier analysis of DFS of patients by Triple negative subtype with breast cancer. J, Kaplan‐Meier analysis of OS of patients by Triple negative subtype with breast cancer
Figure 4
Figure 4
DFS and OS of patients for the SII by Miller and Payne grade (MPG) with breast cancer. A, Kaplan‐Meier analysis of DFS of patients by MPG‐A group with breast cancer. B, Kaplan‐Meier analysis of OS of patients by MPG‐A group with breast cancer. C, Kaplan‐Meier analysis of DFS of patients by MPG‐B group with breast cancer. D, Kaplan‐Meier analysis of OS of patients by MPG‐B group with breast cancer. E, Kaplan‐Meier analysis of DFS of patients by MPG‐C group with breast cancer. F, Kaplan‐Meier analysis of OS of patients by MPG‐C group with breast cancer
Figure 5
Figure 5
DFS and OS of patients for the SII by ER status with breast cancer. A, Kaplan‐Meier analysis of DFS of patients by ER negative with breast cancer in core needle biopsy. B, Kaplan‐Meier analysis of OS of patients by ER negative with breast cancer in core needle biopsy. C, Kaplan‐Meier analysis of DFS of patients by ER positive with breast cancer in core needle biopsy. D, Kaplan‐Meier analysis of OS of patients by ER positive with breast cancer in core needle biopsy. E, Kaplan‐Meier analysis of DFS of patients by ER negative with breast cancer in post‐operative pathology IHC. F, Kaplan‐Meier analysis of OS of patients by ER negative with breast cancer in post‐operative pathology IHC. G, Kaplan‐Meier analysis of DFS of patients by ER positive with breast cancer in post‐operative pathology IHC. H, Kaplan‐Meier analysis of OS of patients by ER positive with breast cancer in post‐operative pathology IHC
Figure 6
Figure 6
DFS and OS of patients for the SII by Ki‐67 status with breast cancer. A, Kaplan‐Meier analysis of DFS of patients by Ki‐67 negative with breast cancer. B, Kaplan‐Meier analysis of OS of patients by Ki‐67 negative with breast cancer. C, Kaplan‐Meier analysis of DFS of patients by Ki‐67 positive with breast cancer. D, Kaplan‐Meier analysis of OS of patients by Ki‐67 positive with breast cancer
Figure 7
Figure 7
DFS and OS of patients for the SII by lymph vessel invasion status with breast cancer. A, Kaplan‐Meier analysis of DFS of patients by lymph vessel invasion negative with breast cancer. B, Kaplan‐Meier analysis of OS of patients by lymph vessel invasion negative with breast cancer. C, Kaplan‐Meier analysis of DFS of patients by lymph vessel invasion positive with breast cancer. D, Kaplan‐Meier analysis of OS of patients by lymph vessel invasion positive with breast cancer

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