Abstract:

Objective To investigate the predictive value of systemic inflammation response index （SIRI） before treatment for pathological complete response （pCR） in patients with breast cancer undergoing neoadjuvant chemotherapy. Methods The clinicopathological data of 119 patients with primary breast cancer undergoing neoadjuvant chemotherapy and subsequent breast-conserving or modified radical surgery from Cangzhou Central Hospital of Hebei Province between January 2010 to March 2020 were retrospectively analyzed, and patients were divided into pCR group （n=19） and non-pCR group （n=100） based on postoperative pathology. The SIRI before treatment between the two groups was compared. The patients were divided into SIRI≤0.25 （n=10）, 0.26-0.50 （n=42）, 0.51-0.75 （n=29）, 0.76-1.00 （n=19）, and >1.00 （n=19） groups according the SIRI before treatment, and the pCR ratios of the five groups were compared. Spearman correlation analysis was applied to evaluate the relationship between SIRI before treatment and pCR, logistic regression analysis was used to identify the influencing factors of pCR for neoadjuvant chemotherapy in breast cancer patients, and receiver operating characteristic （ROC） curve was used to evaluate the predictive value of SIRI before treatment for pCR of neoadjuvant chemotherapy in breast cancer patients. Results Tumor size （Z=2.26, P=0.024）, axillary lymph node metastasis （χ²=5.73, P=0.017）, human epidermal growth factor receptor-2 （HER-2） （χ²=8.77, P=0.003）, Ki-67 （Z=2.68, P=0.007）, cytological nuclear grade （χ²=5.08, P=0.024）, neutrophil count before treatment （Z=2.44, P=0.015）, monocyte/lymphocyte ratio before treatment （Z=3.04, P=0.002）, and SIRI before treatment （Z=3.29, P=0.001） had statistical differences between the pCR and non-pCR groups. The pCR ratios were 50% （5/10） in the SIRI ≤0.25 group, 21% （9/42） in the 0.26-0.50 group, 10% （3/29） in the 0.51-0.75 group, 11% （2/19） in the 0.76-1.00 group, and 0 （0/19） in the >1.00 group, with a statistic difference （χ²=14.28, P=0.006）. SIRI before treatment was negatively related with pCR （r=-0.30, P=0.001）. Univariate logistic regression analysis showed that tumor size （OR=0.50, 95%CI： 0.28-0.89, P=0.019）, axillary lymph node metastasis （OR=5.43, 95%CI： 1.19-24.83, P=0.029）, HER-2 （OR=7.54, 95%CI： 1.65-34.36, P=0.009）, Ki-67 （OR=1.03, 95%CI： 1.01-1.05, P=0.008）, cytological nuclear grade （OR=0.20, 95%CI： 0.04-0.92, P=0.038）, neutrophil count before treatment （OR=0.54, 95%CI： 0.32-0.92, P=0.023）, monocyte/lymphocyte ratio before treatment （OR=0.00, 95%CI： 0.00-0.01, P=0.007）, and SIRI before treatment （OR=0.03, 95%CI： 0.00-0.37, P=0.007） were influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. Multivariate logistic regression analysis confirmed that tumor size （OR=0.31, 95%CI： 0.14-0.72, P=0.007）, axillary lymph node metastasis （OR=10.97, 95%CI： 1.35-89.61, P=0.025）, HER-2 （OR=6.47, 95%CI： 1.18-35.65, P=0.032）, Ki-67 （OR=1.04, 95%CI： 1.00-1.07, P=0.029）, cytological nuclear grade （OR=7.87, 95%CI： 1.01-61.35, P=0.049）, and SIRI before treatment （OR=0.03, 95%CI： 0.00-0.58, P=0.020） were independent influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. The ROC curve showed that the area under the curve of SIRI before treatment for predicting pCR was 0.74 （95%CI： 0.65-0.82）, sensitivity was 68.0%, and specificity was 75.3%. The area under the curve of monocyte/lymphocyte ratio before treatment for predicting pCR was 0.72 （95%CI： 0.63-0.80）, sensitivity was 48.0%, and specificity was 84.2%. The area under the curve of neutrophil count before treatment for predicting pCR was 0.68 （95%CI： 0.59-0.76）, sensitivity was 61.0%, and specificity was 83.7%. Conclusion SIRI before treatment may serve as a marker for predicting pCR in patients with breast cancer undergoing neoadjuvant chemotherapy,patients with low SIRI are more likely to obtain pCR.

Key words: Breast neoplasms, Neoadjuvant chemotherapy, Inflammation