Correlation Between Nutritional/Inflammation Index And Neoadjuvant Chemotherapy Efficacy For Breast Cancer

Objective:Locally advanced breast cancer has a higher risk of recurrence and metastasis.Neoadjuvant(preoperative)chemotherapy has become a routine treatment for locally advanced breast cancer or early breast cancer with triple-negative,Her-2 positive,lymph node metastasis and high proliferation index.Previous studies have shown that patients who achieved pathological complete remission after completing preoperative chemotherapy had significantly improved DFS and OS.However,neoadjuvant chemotherapy is not effective for all breast cancer patients,so it is necessary to predict the outcome of neoadjuvant chemotherapy and identify accurate and effective predictors.The nutritional status of patients is related to the prognosis of various malignant tumors.At present,there are few studies on the efficacy of albumin(ALB)and prognostic nutritional index(PNI)in neoadjuvant chemotherapy for breast cancer.The purpose of this paper is to explore the predictive value of ALB and PNI on the efficacy of neoadjuvant chemotherapy and their correlation with different clinicopathological factors.Methods:From 2013 to 2017,a total of 121 breast cancer patients who received neoadjuvant chemotherapy in breast surgery department and oncology department of our hospital were collected for retrospective analysis.Diagnosed with invasive breast cancer.The clinical,pathological data and hematological indexes(blood routine,blood biochemistry)of these patients were collected;according to the postoperative pathology,the patients were divided into pathological complete remission group(p CR)and non-pathological complete remission group(non-p CR).Statistical analysis methods such as chi-square test,Wilcox rank sum test,ROC curve,Kruskal-Wallis test(KW/F test)and Mann-Whitney U test(U test)were used to further clarify the effect of ALB and PNI on breast cancer.Predictive value of neoadjuvant chemotherapy response and correlation with pathological and clinical factors.The analysis software used SPSS 26.0.Results:Among the 121 breast cancer patients,27 were Luminal A,26 were Luminal B,27 were Her-2 positive hormone receptor negative,11 were Her-2 positive hormone receptor positive,and 23 were triple negative.All patients chose modified radical mastectomy after neoadjuvant chemotherapy.After neoadjuvant chemotherapy,17.36% of patients achieved p CR.After univariate analysis,ER status(P = 0.001),PR status(P = 0.031),and pathological type(P = 0.001)were all correlated with p CR,and patients with negative ER status,negative PR status,and non-luminal type were more likely to p CR is easily reached.In addition,PNI(P = 0.014),ALB(P<0.001)and p CR rate were significantly correlated.Logistic multivariate regression analysis that considered ER status,PR status,pathological type,PNI,and ALB found that PNI(OR = 1.159,95% CI was 1.016-1.321,P = 0.028),ALB(OR = 1.356,95% CI was1.131-1.624,P = 0.001)and p CR rate was significantly correlated,and patients with higher PNI and ALB were more likely to obtain p CR.In addition,ER status(OR =0.148,95% CI: 0.041-0.534,P = 0.015),PR status(OR = 0.214,95% CI: 0.047-0.973,P= 0.046),pathological type(OR = 0.119,95% CI ranged from 0.026 to 0.537,P =0.006)could predict p CR,and patients with negative ER status,negative PR status,Her-2 positive,and triple negative were more likely to achieve p CR.The ROC curve of ALB and PNI to predict the efficacy of neoadjuvant chemotherapy was drawn.The value corresponding to the maximum Youden index was the optimal clinical cutoff value(cutoff point),and the corresponding area under the curve(AUC value)was calculated.The results showed that the cutoff value of albumin was 43.25(specificity46.0%,sensitivity 95.2%,area under the curve 0.746),and the cutoff value of PNI was 55.525(specificity 73.0%,sensitivity 61.9%,area under the curve 0.670);The area under the albumin curve is greater than that of PNI.Using Mann-Whitney U to test the relationship between ALB and PNI levels and postoperative immunohistochemistry,it was found that the ALB level of patients in the KI-67>30%group was higher than that in the KI-67≤30% group.Conclusion:ALB and PNI are correlated with the efficacy of neoadjuvant chemotherapy for breast cancer.Higher levels of ALB and PNI may indicate better efficacy of neoadjuvant chemotherapy in breast cancer patients.ALB is more sensitive than PNI in predicting the efficacy of neoadjuvant chemotherapy.