Inflammatory scores are not interchangeable during the perioperative period of breast cancer surgery

Abstract

Introduction: Inflammatory biomarkers and scores are important prognostic factors in breast cancer, and are proposed during the perioperative period. Here, we investigate their correlation and concordance in breast cancer surgical patients. Patients and methods: With the IRB approval and written informed consent, we included 14 patients (median age: 61 [41 to 82] years) scheduled for conservative surgery (n = 12) or mastectomy (n = 2) for breast cancer. We measured, at baseline, day+1 and day+8, albumin (Alb), C-Reactive Protein (CRP), total white blood cell counts (WBC), lymphocytes (L) and neutrophils (N) counts, and calculated the following inflammatory scores: Neutrophil-to-lymphocyte ratio (NLR), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). A linear regression model is used to compare CRP and NLR, and the Kappa statistic to detect discordance (<0) or agreement (>0.4) between the scores. Results: We measured 170 laboratory values and calculated 182 inflammatory scores. CRP, WBC, N and NLR are significantly different at day+1 compared with baseline (respectively, at baseline, day+1 and day+8 (median[IQR 25–75]): CRP: 0.1[0.1–0.6], 0.85[0.2–1.18], 0.18[0.1–0.4]mg/dL; WBC: 6.36[5.91–7.16], 7.45[6.38–8.16], 7.73[6.25–8.54] × 103/mm3; N: 3.78[3.21–4.2], 5.05[4.37–5.99] × 103/mm3; and NLR: 1.95[1.67–2.46], 2.62[2.36–3.73], 2.23[1.46–2.43]) (P < 0.05 for all the comparisons between baseline and day+1). Alb and L tend to decrease (P = 0.06). Discordance is clear between all the inflammatory scores (NLR, mGPS, PI, PNI) (Kappa<0). Conclusion: Inflammatory biomarkers and scores, like CRP, WBCs, N, NLR, PNI, and PI are modified after a breast cancer surgery, but with discordance and no interchangeability.