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.
Highlights
Breast cancer is one of the most frequent female malignancies and is the second cause of morbidity and mortality in women all over the world.[1]
The results indicated that the incidence of disease-free survival (DFS) and overall survival (OS) in patients with low systemic immune-inflammation index (SII) was higher than that in patients with high SII in 3, 5- and 10-year rates
For all enrolled patients with breast carcinoma, the results indicated that the DFS and OS time in patients with low SII were significantly longer than that in those patients with high SII in HER2-enriched subtype (χ2 = 4.448, P = .035 and χ2 = 4.371, P = .037, respectively; Figure 3G, H)
Summary
Breast cancer is one of the most frequent female malignancies and is the second cause of morbidity and mortality in women all over the world.[1]. Because of the progress of early diagnosis and the improvement of treatment strategy, lots of patients have been successfully treated, and the average 5-year survival rate is around 90%.6 approximately 20%25% patients are diagnosed with locally advanced breast cancer, and these patients account for early relapse and deaths.[7,8] A large number of studies have proved that surgery combined with adjuvant chemotherapy and radiotherapy can effectively improve the survival rate of patients according to the progress of early detection and treatment.[9,10,11]
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