Correlation Analysis Of Nutritional Risk Index With The Efficacy And Prognosis Of Neoadjuvant Chemotherapy For Breast Cancer

Background and Objective:According to cancer statistics,breast cancer has surpassed lung cancer as the most prevalent malignant tumor in women,with more than 2 million cases diagnosed each year worldwide,causing a huge disease burden.Although the treatment level of breast cancer is improving year by year,and the 5-year survival rate is as high as 90%,which is much higher than other cancer types,local recurrence and distant metastasis of breast cancer are still common,and the survival outcome for this group of breast cancer patients is still worrying.Neoadjuvant chemotherapy plays a very important role in clinical practice as an important part of the whole management of breast cancer.Several previous studies have confirmed that breast cancer patients with p CR after neoadjuvant chemotherapy have a better long-term prognosis than those without p CR.Therefore,how to predict the efficacy of neoadjuvant chemotherapy for breast cancer is a question that deserves in-depth study.The progression and metastasis of cancer depends not only on the type of tumor,the severity of staging and grading,and the way and method of treatment,but also on the nutritional level of the patient.A large body of evidence-based medical evidence shows that malnutrition decreases the response to antitumor therapy,increases the incidence of postoperative complications,and leads to a poorer survival prognosis.The nutritional risk index(NRI)is a novel nutrition-related scoring system based on a patient’s ideal weight,current weight and serum albumin levels.As a simple,objective and inexpensive laboratory index,the predictive value of NRI has been demonstrated in a variety of solid tumors,including breast cancer.However,few studies have used NRI to predict the efficacy and prognosis of neoadjuvant chemotherapy in breast cancer.Therefore,the aim of this study was to investigate the predictive role of NRI on p CR rate as well as prognosis after neoadjuvant chemotherapy for breast cancer.Methods:The clinical data of 109 female breast cancer patients admitted to the Department of Breast Surgery of Henan Provincial People’s Hospital with a first diagnosis of breast cancer from January 2016 to January2018 were retrospectively analyzed,and all patients received standard and complete cycles of neoadjuvant chemotherapy before surgery.The optimal cut-off value of NRI was determined based on the functional characteristic curve(ROC)of the subjects,and the relationship between NRI and p CR was analyzed by logistic univariate and multifactorial regression,and survival analysis was performed using Kaplan-Meier survival curves and Cox proportional risk models.Results:A total of 109 breast cancer patients receiving neoadjuvant chemotherapy was enrolled in this study,and the optimal cut-off value of NRI was determined to be 110.95 based on the subjects’ ROC,and the patients were divided into a high NRI group(≥110.95)and a low NRI group(<110.95).Logistic univariate regression analysis showed a significant correlation between NRI and p CR rate after neoadjuvant chemotherapy for breast cancer(OR=5.03,95%CI: 2.09～12.29,P<0.001),and breast cancer patients in the high NRI group were more likely to achieve p CR after neoadjuvant chemotherapy compared to those in the low NRI group(P<0.05);in addition,the tumor stage(OR=0.2,95% CI:0.08～0.49,P<0.001),HR status(OR=0.16,95% CI: 0.05～0.58,P=0.005),HER2 status(OR=6.23,95% CI:2.48～15.67,P<0.001),and Ki67 index(OR= 4.48,95% CI: 1.84～10.92,P=0.001)was all associated with p CR rates: breast cancer patients with stage II tumor stage,HR-negative,HER2-positive,and Ki67≥30%were more likely to achieve p CR after neoadjuvant chemotherapy;Logistic multifactorial regression analysis showed that NRI(OR=4.08,95% CI: 1.17～14.18,P=0.027),tumor stage(OR=0.15,95% CI: 0.04～0.49,P=0.002),HR status(OR=0.09,95% CI: 0.02～0.46,P=0.004),and HER2 status(OR=8.6,95% CI: 2.63～28.15,P<0.001)were independent predictors of neoadjuvant chemotherapy efficacy in breast cancer(P<0.05).Breast cancer patients with stage II tumor stage,HRnegative,HER2-positive and NRI ≥ 110.95 were more likely to achieve p CR after neoadjuvant chemotherapy.In addition,Kaplan-Meier survival curves were plotted based on the survival of patients in the high and low NRI groups,and it was found that there was a significant difference in 5-year disease-free survival(DFS)between the two groups,with the high NRI group having a higher DFS than the low NRI group(P=0.022).Multifactorial analysis using Cox proportional risk regression model showed that there was a significant difference in DFS between the high and low NRI groups(HR=0.319,95%CI: 1.104-0.98,P=0.026),with patients in the low NRI group having a worse prognosis.In addition,tumor stage(HR=13.434,95%CI: 1.781～101.314,P=0.012)and whether p CR was achieved(HR=0.035,95%CI:0.007～1.334,P=0.015)also effectively predicted DFS,that is,breast cancer patients with stage III tumor stage and those who did not achieve p CR after neoadjuvant chemotherapy had worse prognosis.Conclusion:1.HR status,HER2 status,tumor stage and NRI were closely related to p CR after neoadjuvant chemotherapy for breast cancer: breast cancer patients with stage II tumor stage,HR negative,HER2-positive and NRI≥110.95 had higher p CR rate after receiving neoadjuvant chemotherapy.2.NRI may be a predictor of prognosis in patients with breast cancer,and those with NRI <110.95 have a poorer prognosis.