| Objective:Based on the systemic immune inflammatory index(SII)and clinicopathological characteristics(such as age,BMI,menstrual status,tumor size,lymph node status,expression intensity of estrogen and progesterone receptor,human epidermal growth factor 2 receptor,value-added index ki-67)indicators,to explore the correlation between the level of SII before treatment and clinicopathological characteristics as well as the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer,expected to provide reference for clinical decision-making.Methods:From June 2019 to June 2022,106 patients with breast cancer diagnosed by pathology for the first time and treated by surgery after a complete course of neoadjuvant chemotherapy were selected from the First Affiliated Hospital of Gannan Medical College.Collected the clinical andpathological data of all patients and peripheral blood parameters before treatment,including age,sex,height,weight,menstrual status,initial tumor size,lymph node status,tumor lateral position and quadrant,histological type,histological grade,immunohistochemical data,ki-67,and peripheral blood neutrophil,lymphocyte,platelet count,MP grade after neoadjuvant chemotherapy,pathological stage,etc.SII is calculated by(neutrophils ×platelet)/lymphocyte,and the MP(Miller-Payne)grade after NAC is used as the index to evaluate the therapeutic effect.The MP grade 1-3 is defined as non-major histologic response(NMHR)and 4-5 is defined as major histologic response(MHR).According to this standard,the subjects were divided into NMHR group(MP1-3 group)and MHR group(MP4-5 group),and determined the best cutoff value by drawing the ROC curve of SII and MHR,then divided SII into high group and low group.SPSS20.0 statistical software was used to analyze and process the data.Mmeasurement data were compared by t test,count data and grade data were compared by Chi-square test and Kruskal-Wallis test(K-W/F test);The correlation between SII,clinicopathological characteristics and the efficacy of neoadjuvant chemotherapy was analyzed by univariate and multivariate binary logistic regression,then try to find independent factors that can predict the efficacy of neoadjuvant chemotherapy,and the standardized regression coefficientwas calculated to compare the relative importanceof each factor.Results:1.Atotal of 106 patients receiving neoadjuvant chemotherapy were included in this study,with a median age of 45 years(age range 22-71 years).Of the 106 patients,38 had menopause,and 54 had tumors in the left breast.All patients with invasive ductal carcinoma accounted for91.51%,a total of 97 cases,of which 79 cases were in the histologic grade II group had the most patients.Of all the patients,74 patients were diagnosed with axillary lymph node metastasis by pathological biopsy,and 99 patients had clinical T stage 2 and above.There were53 and 62 patients with negative expression of ER and PR,respectively.Atotal of 4 Luminal A patients,36 Luminal B patients,48 HER-2 positive breast cancer patients and 18 TNBC breast cancerpatients were included inthis study.Among all patients,40 patients had MPgrade 5 after NAC,35 patients had pathological complete remission(p CR),and HER-2 positive breast canceraccounted for 75% of MPgrade5 patients.2.Drawthe ROC curve of SII and MHR to get the best cutoff value of SII is 643.2379,SII is divided into low group and high group according to SII truncation value.By analyzing the relationship between SII and clinicopathological characteristics,it was found that there was a statistically significant difference between the level of SII and age(P=0.001),BMI(P<0.001),menopause or not(P=0.002).The average age and BMI of the low SII group were higher than those of the high SII group,and the proportion of menopausal patients in the low SII group was higher.Analyzing the relationship between the clinicopathological characteristics and the efficacy of SII and NAC showed that there were significant differences between the lymph node status(P=0.001),ER(P<0.001),PR(P=0.003),HER-2(P<0.001),ki-67(P=0.006),moleculartyping(P<0.001),SII(P=0.009)and theefficacy of NAC.Lymph nodenegative,ER and PR negative,HER-2 positive,ki-67>30 and low SII have higher MHR rate.3.Univariate analysis showed that lymph node negative(P=0.002),ER negative(P=0.001),PR negative(P=0.001),HER-2 positive(P<0.001),high ki-67(P=0.008),and low SII(P=0.01)were the related factors of histological significant response.The age,BMI,orientation,menstrual status,histological grade,T stage and molecular typing of patients were not significantly correlated with the efficacy of neoadjuvant chemotherapy(P>0.1).The above variables were included in the multivariate binary logistic regression analysis.The results showed that the lymph node status,ER,HER-2 status and SII levels were significantly correlated with the efficacy of neoadjuvant chemotherapy.The probability of MHR in patients with lymph node positive was 0.203 times higher than that in patients with lymph node negative(P=0.016,95% CI 0.056-0.741);The probability of reaching MHR in patients with weakly positive to moderately positive(+-2+)ER expression was 0.169 times higher than that in patients with negative(-)ER expression(P=0.041,95% CI 0.031-0.929);The probability of reaching MHR in HER-2 positive patients is 9.543 times higher than that in HER-2 negative patients(P<0.001,95% CI 2.990-30.459).The probability of reaching MHR in the high SII group was 0.2 times higher than that in the low SII group(P=0.006,95% CI 0.063-0.633).Further calculation of the standardized regression coefficient showed that the relative importance of ER,HER-2 and lymph node status in the histologically significant response(MHR)was ER(-0.853)>HER-2(-0.736)>lymph node status(-0.581).Single factor analysis showed that lymph node negative(P=0.002),ER negative(P=0.001),PR negative(P=0.001),HER-2 positive(P<0.001)were the related factors of MHR.In addition,high ki-67 and low SII also tend to have MHR(P<0.1).However,the age,BMI,orientation,menstrual status,histological grade,clinical T stage and molecular typing of patients were not significantly correlated with the efficacy of neoadjuvant chemotherapy(P>0.1).The above variables which P<0.1 were included in the multivariate binary logistic regression analysis.The results showed that the lymph node status,ER and HER-2 status,SII levels were significantly correlated with the MHR rate of neoadjuvant chemotherapy,among which the probability of reaching MHR in lymph node positive patients was 0.203 times that in lymph node negative patients(P=0.016,95% CI 0.056-0.741);The probability of ER(+-2+)patients reaching MHR is 0.169 times that of ER(-)patients(P=0.041,95% CI 0.031-0.929);The probability of reaching MHR in HER-2 positive patients is 9.543 times higher than that in HER-2 negative patients(P<0.001,95% CI 2.990-30.459).Further calculation of the standardized regression coefficient showed that the relative importance of ER,HER-2 and lymph node status in the histologically significant response(MHR)was ER(-0.853)>HER-2(-0.736)>lymph node status(-0.581).Conclusion:1.SII level,lymph node status,HER-2 status and ER expression intensity are significantly correlated with the efficacy of neoadjuvant chemotherapy and can be used as independent factors to predict the efficacy of neoadjuvant chemotherapy.Low SII level,lymph nodes negative,HER-2 positive,ER negative indicates betterefficacy.2.The relative importance of ER,HER-2,lymph node status in major histologic response(MHR)is ER >HER-2 > lymph nodestatus3.SIIlevels are closely related tomenstrual status,age,and BMI... |
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