We aimed to reveal the prognostic value of the inflammatory-nutritional prognostic score (INPS), a new scoring system using immune-nutritional markers, in breast cancer with NACT.
Patients who were treated in Dokuz Eylul University Department of Medical Oncology and diagnosed breast cancer with NACT were included in this study retrospectively.We selected the most valuable biomarkers (Alb, Alb/ALP Ratio (AAR), ALBI, CRP, CRP/Alb Ratio,HALP, LDH, MLR, NLR, PLR, PNI, SII) to develop INPS by the least absolute shrinkage and selection operator (LASSO) Cox regression model. A prognostic nomogram incorporating INPS and other independent clinicopathological factors was developed based on the stepwise multivariate Cox regression method. The retained features with nonzero coefficients were used to establish a novel INPS. The selected four biomarkers were used to construct the novel INPS for our patients.Survival curves by INPS status were generated using the Kaplan-Meier method with logrank tests.
Median follow-up time of 98 patients was 22.1 months(95% CI= 2.2-149.3) and DFS was 24.0 months (95%CI= 4.8-128.0 ). While 13.3% (n=13) of the patients relapsed, also 7.1% (n=7) died. The 98 patients were randomly divided into the train (n = 65) and test (n = 33) sets in a 2:1 ratio. Using the LASSO Cox regression model, four inflammatory-nutritional biomarkers with nonzero coefficients, namely, AAR, ALBI, LDH, and CRP, of the 14 parameters were selected.The optimum cut-off value was determined for these four markers according to DFS, and the groups were divided into low and high according to these cut-off values for INPS. Kaplan-Meier curves in both the train and test sets showed significant differences in the survival probabilities of the low INPS and high INPS groups. A prognostic nomogram including INPS and other independent clinicopathological factors was developed.
In breast cancer patients receiving NACT, it has been shown for the first time in the literature that INPS, created with immune-nutritional markers, can be used as a prognostic tool on DFS in this patient group.
The authors.
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All authors have declared no conflicts of interest.