| ObjectiveThe objective of this study was to investigate the systemic immune-inflammation index(SII)、neutrophil-to-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)on the prognosis of breast cancer patients and analysis of its related influencing factors.MethodsRetrospective analysis was performed on data of 618 women with breast cancer who satisfied the inclusion criteria got surgical treatment at Shandong University’s Qilu Hospital’s Breast Surgery Department from January 2009 to December 2015.Surgical age,menstrual status,tumor size,axillary lymph node metastasis,vascular tumor thrombi infiltration,histological grade,molecular typing,ER,PR,HER2 receptor expression status,were collected,and corresponding values of SII,NLR and PLR were calculated by collecting preoperative blood routine results of patients.The cut-off values of SII,NLR and PLR were determined by ROC curve method and taken as the critical value of grouping.Patients were separated into two groups:high value and low value.To assess the connection between categorization variables and clinicopathological aspects of patients,the Chi-square test was performed.The five-year disease-free survival rate and five-year overall survival rate were analyzed by Kaplan-Meier drawing and log-rank test.The risk factors affecting patient prognosis were studied using univariate and multivariate Cox proportional risk regression models.Results1.The ROC curve method was used to determine the optimal truncation value of SII was 390.39(AUC=0.731,95%CI 0.666-0.797),and the optimal truncation value of NLR was 1.80(AUC=0.703,95%CI 0.632-0.774).The optimal truncation value of PLR was 151.78(AUC=0.630,95%CI 0.548-0.712).According to the critical value,subjects were divided into low SII group(≤390.39)and high SII group(>390.39),low NLR group(≤1.80)and high NLR group(>1.80),low PLR group(≤151.78)and high PLR group(>151.78).2.Chi-square test results showed that:Preoperative SII level was correlated with menstrual status(χ2=5.618,P=0.018),tumor histological grade(χ2=7.908,P=0.019),the number of axillary lymph node metastasis(χ2=6.296,P=0.043),and vascular tumor plug infiltration(χ2=4.297,P=0.038).There was no statistical correlation with age,tumor size,ER,PR,HER2 and tumor molecular typing(P>0.05).Preoperative PLR level was correlated with patients’ age(χ2=11.817,P=0.001),menstrual status(χ2=13.272,P<0.001),tumor molecular type(χ2=10.075,P=0.018),vascular tumor plug infiltration(χ2=5.152,P=0.023).There was no significant correlation with tumor size,tumor histological grade,ER,PR,HER2 and axillary lymph node metastasis(P>0.05).There was no statistical correlation between preoperative NLR level and clinicopathological features(P>0.05).3.Patients in the high SII group had an 87.0 percent five-year disease-free survival rate,whereas those in the low SII group had a 99.2 percent five-year disease-free survival rate.The difference between the two groups was significant(P≤0.001).The high NLR group had an 86.6 percent disease-free survival rate,while the low NLR group had a 96.6 percent disease-free survival rate.The difference between the two groups was significant(P≤0.001).In the high PLR group,the five-year disease-free survival rate was 87.4 percent,while in the low PLR group,it was 94.4 percent.The difference between the two groups was significant(P=0.003).The high SII group had a five-year overall survival rate of 93.5 percent,while the low SII group had a rate of 99.6 percent.The difference between the two groups was significant(P≤0.001).The high NLR group had a five-year overall survival rate of 94.0 percent,while the low NLR group had a five-year overall survival rate of 97.7%.The difference between the two groups was significant(P=0.019).The high PLR group had a five-year overall survival rate of 93.7 percent,while the low PLR group had a five-year overall survival rate of 97.2 percent.The difference between the two groups was significant(P=0.039).4.COX univariate analysis showed that:tumor size(P=0.019),expression of ER(P=0.001),expression of PR(P=0.004),molecular typing(P<0.05),number of axillary lymph node metastasis(P<0.05),SII(P<0.001),NLR(P<0.001),PLR(P=0.022)were associated with the disease free survival.COX multivariate analysis showed that SII(HR=6.343,95%CI 2.077-19.369,P=0.001)and axillary lymph node metastasis(HR=2.407,95%CI 1.089-5.318,P=0.03;≥4 lymph node metastases:HR=6.624,95%CI 3.147-13.939,P<0.001)were independent prognostic factors of breast cancer.ConclusionThe preoperative level of SII was related to the patient’s menstrual status,tumor histological grade,the number of axillary lymph node metastasis,and vascular tumor plug infiltration.Preoperative PLR level was related to patients’ age,menstrual status,tumor molecular classification,and vascular tumor plug infiltration.High preoperative SII,NLR and PLR are all associated with reduced survival rate of breast cancer patients,but only SII is an independent risk factor affecting the prognosis of breast cancer patients,and SII may become a prognostic marker of breast cancer patients. |
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