Predictive Value Of Systemic Inflammatory Response Index On The Efficacy Of Neoadjuvant Chemotherapy In Breast Cancers Patients

Background: The systemic inflammation response index（SIRI）,has been reported to be closely related to prognosis in many tumors,such as breast and gastric cancers.However,the predictive value of SIRI on the efficacy of neoadjuvant chemotherapy（NAC）in breast cancer patients is unknown.This study examined the correlation between SIRI and the efficacy of NAC in patients with breast cancer receiving NAC and identified convenient and accurate predictive indicators for the efficacy of NAC.Methods: We retrospectively analyzed the clinicopathological parameters and pretreatment peripheral blood characteristics of the 241 patients with breast cancer who received NAC between June 2015 and June 2020.Receiver operating characteristic（ROC）curves were used to determine the optimal cutoff value of the inflammation markers.ROC curves were also plotted to verify the accuracy of inflammatory markers for pathological complete response（p CR）prediction.The chi-squared test was used to explore the relationships of p CR with SIRI and other clinicopathological parameters.Multivariate analyses were performed using a logistic regression model.Results: In this study,we collected the clinic data of 299 breast cancer patients who received NAC.According to the inclusion and exclusion criteria,241 breast cancer patients were finally included for analysis.The best cutoff value for SIRI,neutrophil to lymphocyte ratio（NLR）,lymphocyte to monocyte ratio（LMR）,and absolute lymphocyte count（ALC）were 0.72,1.77,5.38 and 1.57 respectively.Among 241 breast cancer patients,only 48（19.92%）patients achieved p CR after NAC.The median age at diagnosis was 48 years old.There were 116 and 125 patients in the body mass index（BMI）≥ 24 and BMI < 24 groups,respectively.No metastatic lesions were found in the axillary lymph nodes of 84 breast cancer patients at diagnosis.The low and high SIRI groups included 63 and 178 breast cancer patients,respectively.Triple negative breast cancer was detected in 53 patients.HER-2 overexpressing breast cancer was identified in 87 patients,and hormone receptor（HR）positive breast cancer was identified in 101 patients.In this study,clinical T and N stage,BMI,histological grade,molecular subtype,SIRI,NLR,and LMR were statistically associated with p CR.Interestingly,patients with low BMI values had higher p CR rates than those with high BMI values.In addition,lower p CR rates were observed in patients with higher clinical T and N stages.The p CR rates were lower in patients with HR positive breast cancer than in patients with triple negative breast cancer and HER-2 overexpressing breast cancer patients.In addition,patients with low SIRI values had higher p CR rates and patients with low NLR were also observed to have high p CR rates.Patients with high LMR values had high p CR rates.Multivariate analysis showed that only clinical T and N stages,NLR and SIRI retained their statistical correlation with p CR.The area under the ROC curve（AUC）of SIRI was greater than NLR.In patients with SIRI < 0.72,the chance of achieving p CR was nearly 5 times higher than patients with SIRI ≥0.72（OR,4.999;95% CI: 1.510-16.551,P=0.008）.Conclusions: Pretreatment SIRI is predictive of p CR in patients with breast cancer receiving NAC,and the index can assist clinicians in using a simple method to predict the efficacy of NAC and formulating personalized treatment strategies.