Role of inflammation parameters in locally advanced breast cancer: the debate is still open

Abstract

Background: Neoadjuvant chemotherapy (NCT) is the standard treatment strategy for locally advanced breast cancer (BC). Data about clinical utility of blood-derived inflammation parameters as prognostic factors are robust in early BC, while their use in neo-adjuvant setting warrants investigation. Recently, a novel inflammatory parameter, named Systemic mmune-Inflammation Index (SII), obtained by analyzing the neutrophil, lymphocyte and platelet counts, has been proposed as a prognostic factor in some solid tumours as hepatocellular carcinoma, renal cancer and lung carcinoma. Our study aims to investigate the prognostic and predictive value of the SII in locally advanced BC patients treated with NCT. Patients and methods: Data of consecutive patients undergoing NCT for locally BC (stage II-III) between January 2007 and April 2017 were retrospectively reviewed. Pre-treatment SII was calculated by multiplying the absolute platelet (P) and neutrophil (N) counts and dividing by the absolute lymphocyte (L) count. Patients were divided in two groups epending on the cut-off value of SII, calculated by ROC analysis. SII was then correlated with clinical-patological features of BC and with the patologically complete response by χ2 test. Relapse-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Level of significance p value was set at 0.05. Results: A total of 120 patients were enrolled in the study. Median age was 53 years (range 28 − 75 years). The Hormonal Receptor (HR) status was positive in 73 patients (60.8%) and negative in 47 (39.2%); 45 of them (37.5%) presented HER2-positive tumors; 28 patients (23.3%) presented pCR. The best SII cut-off was ≥790 vs. <790 as defined by the ROC analysis. The value of SII showed no correlation with patological complete response, RFS and OS. However, based on χ2 test, low level of SII was related with low pre-chemotherapy MIB-1 proliferation index (p = 0,01). No additional statistically significant relation between the value of SII and other clinical-patological features of BC were found. Conclusion: In our study SII did not show a significant prognostic and predictive impact in patients with locally advanced BC. However, based on the recent results obtained by the use of anti-Programmed death-1 (PD-1)/PD-ligand 1 (PD-L1) agents, the research for reliable inflammatory biomarkers will be a major focus in future years.