Comprehensive prognostic effects of inflammatory and nutritional markers to predict survival in women with breast cancer

BackgroundBreast cancer (BC) is the most prevalent malignancy in women, both worldwide and at the national level. In addition to classic tumor- and patient-related factors affecting BC prognosis, inflammation, and nutritional status were reported to be significantly associated with carcinogenesis, tumor progression, and cancer prognosis. This study aimed to evaluate the comprehensive prognostic effects of inflammatory and nutritional markers in women with BC and provide a reference for the most relevant prognostic indicators.MethodsA total of 221 women with stage I-IV BC enrolled in this study between July 2018 and June 2021 were analyzed retrospectively. The pretreatment inflammatory and nutritional markers included C-reactive protein (CRP), albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), prognostic nutrition index (PNI), and CRP-to-albumin ratio (CAR). The receiving operating curve (ROC) performed the optimal cutoff values. Kaplan-Meier survival analysis, univariate, and multivariate Cox’s proportional hazards regression model were conducted to investigate the effects of the above markers, clinicopathological parameters, and BC treatment on 3-year overall survival (OS).ResultsIn ROC, optimal cutoff values for NLR, PLR, LMR, SII, SIRI, PIV, PNI, and CAR were determined as >1.99, >146, <3.65, >207, >1.305, >542.5, <50.9, and >1.34, respectively. The tumor (T), lymph node (N), metastases (M) stage, molecular subtype, surgery status (mastectomy vs non-mastectomy), NLR, SII, SIRI, PIV, and CAR were significantly associated with 3-year OS in univariate analysis. Further, multivariate analysis showed that patients with T3-4, N1-3, HER2-enriched subtype, NLR>1.99 (HR 2.58, 95%CI 1.04–6.36, p=0.040), and CAR>1.34 (HR 3.15, 95% CI 1.56–6.33, p=0.001) were significantly associated with worse prognosis.ConclusionsBesides the classical survival factors such as T, N, and molecular subtypes, NLR and CAR were significantly associated with the 3-year OS and may serve as prognostic indicators of BC.Legal entity responsible for the studyThe authors.FundingThe Indonesian Ministry of Research, Technology, and Higher Education.DisclosureAll authors have declared no conflicts of interest.