Prognostic and clinicopathological value of systemic inflammation response index (SIRI) in patients with breast cancer: a meta-analysis

Figures & data

Figure 1. PRISMA diagram of literature search and study inclusion.

Table 1. The basic characteristics of included studies.

Author	Year	Country/region	Sample size	Age (years) Median(range)	Study design	Study period	TNM stage	Treatment	Cut-off value of SIRI	Follow-up (months) Median(range)	Survival endpoints	Survival analysis	NOS score
Hua, X.	2020	China	390	68(49–87)	Retrospective	2010–2012	I–III	Surgery	0.54	65.5(0.9–95.9)	OS, DFS	Multivariate	8
Wang, L.	2020	China	949	54(24–89)	Retrospective	2009–2012	I–III	Surgery	0.65	102	OS	Multivariate	7
He, Q.	2021	China	47	52	Retrospective	2016–2020	I–III	NACT + surgery	0.465	10	DFS	Univariate	6
Jiang, C.	2022	China	280	49	Retrospective	2012–2016	II–III	NACT + surgery	0.52	1–120	OS	Multivariate	8
Zhu, M.	2022	China	785	47(22–82)	Retrospective	1998–2016	I–III	NACT + surgery	0.80	1–250	OS, DFS	Multivariate	8
Huang, W.	2023	China	260	46.5(25–76)	Retrospective	2014–2018	I–III	NACT + surgery	1.6	40(1–94)	DFS	Multivariate	7
Yamanouchi, K.	2023	Japan	46	57(38–73)	Retrospective	2008–2020	IV	Chemotherapy	0.83	30(1–146)	OS	Multivariate	7
Wu, H. Y.	2024	Taiwan	240	53(25–79)	Retrospective	2011–2021	I–III	NACT + surgery	1.27	1–140	OS, DFS	Univariate	8

TNM: tumor, node, metastasis; NACT: neoadjuvant chemotherapy; SIRI: systemic inflammation response index; OS: overall survival; DFS: disease-free survival; NOS: Newcastle-Ottawa Scale.

Figure 2. Forest plot of meta-analysis of the relationship between SIRI and OS in patients with BC.

Table 2. Subgroup analysis of the prognostic value of SIRI for OS in patients with breast cancer.

Subgroups	No. of studies	No. of patients	Effects model	HR (95%CI)	p	Heterogeneity
						I^2 (%)	Ph
Total	6	2,690	Random	2.43(1.42–4.15)	0.001	86.0	<0.001
Country/region
China	4	2,404	Fixed	1.76(1.48–2.10)	<0.001	0	0.498
Japan	1	46	–	0.37(0.03–4.47)	0.434	–	–
Taiwan	1	240	–	6.53(4.29–9.96)	<0.001	–	–
Sample size
<300	3	566	Random	3.55(1.13–11.13)	0.030	62.9	0.008
≥300	3	2,124	Fixed	1.73(1.45–2.07)	<0.001	0	0.667
TNM stage
I–III	4	2,595	Random	2.50(1.39–4.48)	0.002	90.9	<0.001
II–III	1	49	–	3.88(1.11–13.55)	0.033	–	–
IV	1	46	–	0.37(0.03–4.47)	0.434	–	–
Treatment
Surgery	2	1,339	Fixed	1.83(1.43–2.36)	<0.001	0	0.515
NACT + surgery	3	1,305	Random	3.39(1.13–10.16)	0.030	93.5	<0.001
Chemotherapy	1	46	–	0.37(0.03–4.47)	0.434	–	–
Cut-off value
<0.80	3	1,619	Fixed	1.89(1.48–2.42)	<0.001	0	0.416
≥0.80	3	1,071	Random	2.29(0.66–7.98)	0.193	93.8	<0.001
Survival analysis
Univariate	1	240	–	6.63(4.29–9.96)	<0.001	–	–
Multivariate	5	2,450	Fixed	1.75(1.47–2.09)	<0.001	0	0.423

TNM: tumor, node, metastasis; NACT: neoadjuvant chemotherapy; SIRI: systemic inflammation response index; OS: overall survival.

Figure 3. Forest plot of meta-analysis of the relationship between SIRI and DFS in patients with BC.

Table 3. Subgroup analysis of the prognostic value of SIRI for DFS in patients with breast cancer.

Subgroups	No. of studies	No. of patients	Effects model	HR (95%CI)	p	Heterogeneity
						I^2(%)	Ph
Total	5	1,722	Random	2.59(0.81–8.24)	0.107	96.6	<0.001
Country/region
China	4	1,482	Fixed	1.51(1.19–1.91)	0.001	0	0.751
Taiwan	1	240	–	10.32(8.01–13.30)	<0.001	–	–
Sample size
<300	3	547	Random	4.71(0.91–24.25)	0.064	93.8	<0.001
≥300	2	1,175	Fixed	1.43(1.10–1.87)	0.008	0	0.722
Treatment
Surgery	1	390	–	1.32(0.78–2.23)	0.298	–	–
NACT + surgery	4	1,332	Random	3.22(0.80–12.88)	0.098	97.1	<0.001
Cut-off value
<0.80	2	437	Fixed	1.34(0.79–2.25)	0.279	0	0.492
≥0.80	3	1,285	Random	3.06(0.75–12.51)	0.120	98.0	<0.001
Survival analysis
Univariate	2	287	Fixed	10.33(8.02–13.31)	<0.001	0	0.813
Multivariate	3	1,435	Fixed	1.50(1.19–1.91)	0.001	0	0.679

TNM: tumor, node, metastasis; NACT: neoadjuvant chemotherapy; SIRI: systemic inflammation response index; DFS: disease-free survival.

Figure 4. Forest plots of the correlations between SIRI and clinicopathological features in BC. (A) Age (year) (≥50 vs <50); (B) T stage (T3–T4 vs T1–T2); (C) N stage (N1–N3 vs N0); and (D) TNM stage (III vs I-II).

Figure 5. Forest plots of the correlations between SIRI and clinicopathological features in BC. (A) ER status (positive vs negative); (B) PR status (positive vs negative); (C) HER2 status (positive vs negative); and (D) Differentiation (poor vs well/moderate).

Table 4. The association between SIRI and clinicopathological features in patients with breast cancer.

Clinicopathological factors	No. of studies	No. of patients	Effects model	OR (95%CI)	p	Heterogeneity
						I^2(%)	Ph
Age (year) (≥50 vs <50)	5	2,664	Fixed	0.87(0.74–1.02)	0.095	1.0	0.401
T stage (T3–T4 vs T1–T2)	6	2,904	Fixed	1.73(1.40–2.14)	<0.001	33.6	0.184
N stage (N1–N3 vs N0)	6	2,904	Fixed	1.61(1.37–1.91)	<0.001	17.8	0.298
TNM stage (III vs I–II)	5	2,664	Fixed	1.63(1.34–1.98)	<0.001	42.5	0.139
ER status (positive vs negative)	4	1,879	Random	0.78(0.54–1.14)	0.200	62.1	0.048
PR status (positive vs negative)	4	1,879	Random	0.88(0.52–1.47)	0.617	81.6	0.001
HER2 status (positive vs negative)	5	2,119	Fixed	0.99(0.81–1.20)	0.912	0	0.980
Differentiation (poor vs well/moderate)	3	1,994	Fixed	1.25(1.02–1.52)	0.028	79.6	0.242

TNM: tumor, node, metastasis; ER: estrogen receptor; PR: progesterone receptor; HER2: human epidermal growth factor receptor-2; SIRI: systemic inflammation response index.

Figure 6. Sensitivity analyses of outcomes. (A) OS. (B) DFS.

Figure 7. Publication bias tested by Begg’s test and Egger’s test. (A) Begg’s test for OS, p = 0.452; (B) Egger’s test for OS, p = 0.709; (C) Begg’s test for DFS, p = 0.806; and (D) Egger’s test for DFS, p = 0.606.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.