The Predictive Value Of Systemic Immunoinflammatory Index And Tumor-infiltrating Lymphocytes On The Efficacy Of Neoadjuvant Chemotherapy In Locally Advanced HER-2 Positive Breast Cancer

Objective: Breast cancer is one of the most common malignancies in women worldwide.With early diagnosis and comprehensive systemic treatment based on surgery,chemotherapy,endocrine and targeted therapies,the mortality rate for these tumors has declined in recent decades.However,some immune factors that may play an important role in the development of breast cancer have not been fully paid attention to.According to the latest epidemiological and clinical studies,there is a mutually deterministic relationship between breast tumors and inflammation.Inflammation is an important part of tumor microenvironment,and changes in inflammatory cells may affect tumor progression,such as tumor cell proliferation,migration,invasion,anti-tumor immune collapse,metastasis,etc.Peripheral blood tests at the time of diagnosis and treatment can reflect inflammation within the tumor.Indicators related to inflammatory response,such as neutrophil-lymphocyte ratio(NLR)and systemic immune inflammation index(SII,neutrophils ×platelets/lymphocytes),have been reported to be associated with prognosis,recurrence and metastasis of various types of cancer.In addition,scientific evidence has also linked the presence of lymphocytes infiltrating carcinoma tissues with improved prognosis.The in-depth study of the relation-ship between common inflammatory markers and the treatment or prognosis of breast cancer has important clinical significance and application prospect,and can provide useful information for clinicians.This paper aims to explore the predictive value of systemic immunoinflammatory index and tumor-infiltrating lymphocytes on the efficacy of neoadjuvant chemotherapy in locally advanced HER-2 positive breast cancer patients,so as to provide new ideas and methods for the prevention and treatment of breast cancer.Methods:We retrospectively analyzed patients with locally advanced HER2+ breast cancer who received neoadjuvant chemotherapy followed by surgery and had complete clinical data at the Breast Center of the Fourth Hospital of Hebei Medical University between 2019.1and 2021.2.According to the inclusion criteria of this study,45 patients were finally enrolled.Neutrophil count,lymphocyte count and platelet count before treatment,TILs count of puncture pathological specimen,and postoperative pathological reaction data were collected.The TILs count is the percentage of cell nests and tumor stroma containing TILs to the total tumor area under the light microscope,and the mean value is defined as the TILs ratio.The proportion of TILs <10%(almost no infiltrating lymphocytes)was considered as the low proportion group,the proportion of TILs 10%-40% was considered as the medium proportion group,and the proportion of TILs≥40%(rich in infiltrating lymphocytes)was considered as the high proportion group.SII was(neutrophil count × platelet count)/lymphocyte count,NLR was neutrophil count/lymphocyte count.Results:1.The PCR rate after neoadjuvant chemotherapy was 48.9%,and the pCR rate of the ER-negative breast cancer patients was 54.5% higher than that of the positive group(45.5%),the difference was statistically significant(P<0.05).In TILS,the PCRR of the high infiltration group was 72.7%,the low infiltration group was 27.3%,the difference was statistically significant(P<0.05),the PCRR of the high SII group was 45.5%,and the low value group was 54.5%,the difference was statistically significant(P<0.05).2.The levels of SII and NLR in PCR group were significantly decreased(P < 0.05);Multivariate analysis showed that TILs,NLR and SII were independent predictors of the efficacy of neoadjuvant chemotherapy in breast cancer(P < 0.05).Conclusions:1.TILS,SII and NLR have certain predictive value on whether patients can achieve PCR after neoadjuvant chemotherapy,and can be used as an effective reference index to predict PCR;2.ER-negative patients have a higher pCR rate after neoadjuvant chemotherapy with positive HER-2,and ER status is an important biomarker to predict the efficacy of neoadjuvant chemotherapy in patients.