Increased systemic immune-inflammation index independently predicts poor survival for hormone receptor-negative, HER2-positive breast cancer patients

Figures & data

Table 1 Patient characteristics of 155 hormone receptor-negative, HER2+ breast cancer patients

Parameters	Number	%
Age (years)
≤35	31	20.0
>35	124	80.0
Tumor stage
T1	29	18.7
T2	84	54.2
T3	35	22.6
T4	7	4.5
Tumor differentiation
I	17	11.0
II	76	49.0
III	52	33.5
Unknown	10	6.5
Lymph node involvement
N0	56	36.1
N1	34	21.9
N2	25	16.1
N3	40	25.8
AJCC stage
I	21	13.5
II	64	41.3
III	70	45.2
Pathological type
IDC	126	81.3
ILC	29	18.7
Ki-67
≤30%	98	63.2
>30%	57	36.8
Surgery
Breast-conserving surgery	15	9.7
Radical mastectomy	140	90.3
Radiotherapy
Yes	92	59.4
No	63	40.6
Chemotherapy
Adjuvant chemotherapy	129	83.2
Neoadjuvant chemotherapy	26	16.8
Targeted therapy
Yes	81	52.3
No	74	47.7
SII
≤578	78	50.3
>578	77	49.7

Abbreviations: AJCC, American Joint Committee on Cancer; SII, systemic immune-inflammation index; IDC, Intraductal Carcinoma; ILC, Intralobular Carcinoma.

Table 2 Univariate analysis for DFS, DMFS and OS

Parameters	DFS		DMFS		OS
	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value
Age (years)
≤35	1		1		1
>35	0.65 (0.43–0.97)	0.038	0.61 (0.41–0.92)	0.020	0.86 (0.56–1.33)	0.514
Tumor stage
T1	1		1		1
T2–4	2.99 (1.84–4.86)	<0.001	2.94 (1.81–4.78)	<0.001	3.51 (2.01–6.12)	<0.001
Tumor differentiation
I–II	1		1		1
III	3.33 (2.26–4.88)	<0.001	3.14 (2.13–4.62)	<0.001	2.71 (1.83–4.02)	<0.001
Lymph node involvement
N0	1		1		1
N1–3	2.20 (1.54–3.17)	<0.001	2.14 (1.49–3.07)	<0.001	2.34 (1.58–3.48)	<0.001
Pathological type
ILC	1		1		1
IDC	0.86 (0.62–1.28)	0.621	0.92 (0.75–1.41)	0.381	1.13 (0.83–1.39)	0.614
Surgery
Breast-conserving surgery	1		1		1
Radical mastectomy	1.57 (0.86–2.84)	0.135	1.53 (0.84–2.78)	0.157	2.07 (1.04–4.10)	0.037
Ki-67
≤30%	1		1		1
>30%	2.65 (2.11–4.15)	<0.001	2.89 (1.82–5.36)	<0.001	2.93 (1.94–4.62)	<0.001
Radiotherapy
No	1		1		1
Yes	1.04 (0.74–1.46)	0.836	0.99 (0.70–1.39)	0.952	0.84 (0.59–1.22)	0.364
Chemotherapy
Adjuvant chemotherapy	1		1		1
Neoadjuvant chemotherapy	0.85 (0.55–1.34)	0.493	0.92 (0.59–1.44)	0.714	1.18 (0.71–1.96)	0.517
Targeted therapy
Yes	1		1		1
No	1.07 (0.76–1.49)	0.692	0.96 (0.68–1.35)	0.819	1.04 (0.72–1.50)	0.839
Neutrophils
≤3.61	1		1		1
>3.61	1.11 (0.79–1.56)	0.518	1.06 (0.75–1.48)	0.729	1.22 (0.85–1.75)	0.276
Lymphocytes
≤1.65	1		1		1
>1.65	0.63 (0.43–0.91)	0.015	0.61 (0.42–0.89)	0.010	0.57 (0.37–0.86)	0.008
Platelets
≤224	1		1		1
>224	1.05 (0.75–1.48)	0.742	1.18 (0.84–1.65)	0.332	1.28 (0.89–1.84)	0.181
NLR
≤2.3	1		1		1
>2.3	1.44 (1.02–2.03)	0.034	1.41 (1.00–1.99)	0.045	1.54 (1.06–2.23)	0.022
PLR
≤160	1		1		1
>160	1.68 (1.20–2.36)	0.003	1.78 (1.26–2.51)	0.001	1.69 (1.17–2.44)	0.005
SII
≤578	1		1		1
>578	1.88 (1.34–2.65)	<0.001	1.81 (1.28–2.55)	0.001	1.79 (1.24–2.60)	0.002

Abbreviations: DFS, disease-free survival; DMFS, distant metastasis-free survival; OS, overall survival; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic immune-inflammation index; IDC, Intraductal Carcinoma; ILC, Intralobular Carcinoma.

Figure 1 Disease-free survival rates of 155 patients with hormone receptor-negative, HER2+ breast cancer according to low and high SII (systemic immune-inflammation index).

Figure 2 Distant metastasis-free survival rates of 155 patients with hormone receptor-negative, HER2+ breast cancer according to low and high SII (systemic immune-inflammation index).

Figure 3 Overall survival rates of 155 patients with hormone receptor-negative, HER2+ breast cancer according to low and high SII (systemic immune-inflammation index).

Table 3 Multivariate analysis for DFS, DMFS and OS

Parameters	DFS		DMFS		OS
	HR (95% CI)	P-value	HR (95% CI)	P-value	HR (95% CI)	P-value
Age (years)
≤35	1		1		/	/
>35	0.79 (0.51–1.21)	0.285	0.72 (0.47–1.11)	0.142	/
Tumor stage
T1	1		1		1
T2–4	2.32 (1.39–3.89)	0.001	2.31 (1.38–3.89)	0.001	2.73 (1.50–4.97)	<0.001
Tumor differentiation
I–II	1		1		1
III	2.42 (1.54–3.81)	<0.001	2.34 (1.49–3.66)	<0.001	1.85 (1.20–2.87)	0.005
Lymph node involvement
N0	1		1		1
N1–3	1.21 (0.77–1.87)	0.396	1.16 (0.75–1.81)	0.485	1.22 (0.75–2.00)	0.409
Surgery
Breast-conserving surgery	/		/		1
Radical mastectomy	/	/	/	/	1.58 (0.73–3.39)	0.238
Ki-67
≤30%	1		1		1
>30%	1.98 (1.36–2.68)	0.001	2.06 (1.74–3.92)	<0.001	2.31 (1.81–3.46)	<0.001
Lymphocytes
≤1.65	1		1		1
>1.65	0.76 (0.51–1.12)	0.174	0.72 (0.48–1.08)	0.116	0.62 (0.40–0.97)	0.039
NLR
≤2.3	1		1		1
>2.3	1.38 (0.96–1.99)	0.081	1.32 (0.92–1.91)	0.130	1.32 (0.90–1.95)	0.153
PLR
≤160	1		1		1
>160	1.23 (0.83–1.82)	0.296	1.36 (0.92–2.02)	0.114	1.34 (0.88–2.04)	0.167
SII
≤578	1		1		1
>578	1.46 (1.01–2.11)	0.045	1.40 (0.96–2.03)	0.078	1.51 (1.02–2.25)	0.038

Notes: Lymphocytes, NLR, and PLR are evaluated using the multivariate Cox regression for DFS, DMFS, and OS alongside other clinicopathological parameters that were found to be statistically significant after the univariate analysis. Only each of lymphocytes, NLR, and PLR alone are listed in this table.

Abbreviations: DFS, disease-free survival; DMFS, distant metastasis-free survival; OS, overall survival; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic immune-inflammation index.

Table 4 Correlation between SII and baseline characteristics

Parameters	SII ≤578	SII >578	P-value
Age (years)
≤35	13	18	0.322
>35	65	59
Tumor stage
T1	20	9	0.038
T2–4	58	68
Tumor differentiation
I–II	53	40	0.119
III	22	30
Lymph node involvement
N0	36	20	0.012
N1–3	42	57
AJCC stage
I	14	7	0.158
II–III	64	70
Pathological type
ILC	12	17	0.310
IDC	66	60
Surgery
Breast-conserving surgery	11	4	0.101
Radical mastectomy	67	73

Abbreviations: AJCC, American Joint Committee on Cancer; SII, systemic immune-inflammation index; IDC, Intraductal Carcinoma; ILC, Intralobular Carcinoma