Preoperative inflammatory status as a positive prognostic factor for triple-negative breast cancer patients receiving neoadjuvant therapy.

Abstract

The aim of this study was to investigate the ability of preoperative systemic inflammatory status to predict the clinical outcomes of triple-negative breast cancer (TNBC) patients who undergo neoadjuvant therapy. This retrospective study included a total of 273 TNBC patients who underwent neoadjuvant therapy at Harbin Medical University Cancer Hospital from January 2017 to December 2021. All patients underwent preoperative blood tests, and the following inflammatory and immune indices were calculated for each patient: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index, systemic inflammatory response index (SIRI), and advanced lung cancer inflammation index. The observed outcomes included progression-free survival (PFS) and overall survival (OS). Survival analysis was performed using Kaplan-Meier survival curves, Cox survival analysis, decision curve analysis, propensity score matching analysis, and a nomogram to comprehensively investigate the impact of inflammatory status on patient survival. This study included a total of 273 TNBC patients with a mean age of 50.25 (9.87) years. Among them, 131 (48.0%) had tumor-node-metastasis stage II disease, and 142 (52.0%) had tumor-node-metastasis stage III disease. A total of 91 patients achieved a pathological complete response following neoadjuvant therapy. Survival analysis revealed that all preoperative inflammatory indices were associated with PFS and OS. Additionally, receiver operating characteristic curves revealed a greater prognostic value for the SIRI. Following the elimination of collinearity through least absolute shrinkage and selection operator regression analysis, the SIRI was identified as an independent prognostic factor in this study. Risk factor scores and nomograms that included the SIRI also demonstrated high accuracy. Even after propensity score matching analysis with a matching tolerance of 0.02 for the SIRI, the SIRI continued to exhibit predictive ability for PFS and OS, indicating its considerable potential in this study. Preoperative inflammatory status was associated with the prognosis of TNBC patients receiving neoadjuvant therapy. Furthermore, the SIRI exhibited the highest prognostic value in this study and could identify postoperative high-risk patients.