The Pretreatment Systemic Inflammation Response Index as a Useful Prognostic Factor is Better Than Lymphocyte to Monocyte Ratio in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Published:March 21, 2022DOI:


      It has been reported that the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR), as well as systemic inflammation response index (SIRI), are closely related with overall survival (OS) in breast cancer patients. However, which one is the optimal indicator is vague. This study incorporates 280 breast cancer patients who received NACT. A cut-off value of LMR, PLR, SIRI and NLR is determined by Youden index. The Pearson's X2 test or Fisher's exact test is applied to compare the correlation of different clinicopathologic characteristics divided by SIRI. The K-M survival curves and log-rank test were applied to determine OS. Univariate and multivariable analysis are explored by the Cox regression model. We apply the Z test to contrast the prognostic capacity of SIRI, LMR, PLR, and NLR. At the meanwhile, we construct the nomogram based on the results of multivariable analysis. All enrolled cases are divided into two parts by pretreatment SIRI (cut-off value = 0.52). Compared to high pre-treatment SIRI, high pre-treatment NLR and clinical T3 + T4 stage, the low pre-treatment SIRI, low pretreatment NLR and clinical T1 + T2 stage had longer OS time. The Z test showed that the SIRI group had bigger AUC than LMR and PLR, and the difference is statistically significant. The ability of nomogram, based on pretreatment SIRI, pre-treatment NLR and clinical T stage, to predict the 3-year, 5-year, and 8-year overall survival rates of breast malignant tumor patients is better than clinical TNM stage. Pre-treatment SIRI was a more crucial and integral prognostic index for breast malignant tumor patients receiving NACT. It could be helpful for doctors to predict the prognosis of breast malignant tumor patients and to evaluate the treatment status of patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Siegel RL
        • Miller KD
        • Jemal A.
        Cancer statistics, 2019.
        CA Cancer J Clin. 2019; 69: 7-34
        • Chen W
        • Zheng R
        • Baade PD
        • et al.
        Cancer statistics in China, 2015.
        CA Cancer J Clin. 2016; 66: 115-132
        • Xie H
        • Liu J
        • Yu S
        • et al.
        Patterns of use of docetaxel-containing adjuvant chemotherapy among chinese patients with operable breast cancer: a multicenter observational study.
        Adv Ther. 2019; 36: 131-146
        • Franceschini G
        • Di Leone A
        • Natale M
        Conservative surgery after neoadjuvant chemotherapy in patients with operable breast cancer.
        Ann Ital Chir. 2018; 89: 290
        • Nam K
        • Eisenbrey JR
        • Stanczak M
        • et al.
        Monitoring neoadjuvant chemotherapy for breast cancer by using three-dimensional subharmonic aided pressure estimation and imaging with US contrast agents: preliminary experience.
        Radiology. 2017; 285: 53-62
        • Savaridas SL
        • Sim YT
        • Vinnicombe SJ
        • et al.
        Are baseline ultrasound and mammographic features associated with rates of pathological completes response in patients receiving neoadjuvant chemotherapy for breast cancer?.
        Cancer Imaging. 2019; 19 (Published 2019 Oct 21): 67
        • He Z
        • Song A
        • Zhang Z
        • et al.
        Comparative efficacy of non-pharmacological adjuvant therapies for quality of life in the patients with breast cancer receiving chemo- or radio-therapy: A protocol for systematic review and Bayesian network meta-analysis.
        Medicine (Baltimore). 2018; 97: e12096
        • Zheng T
        • Wang A
        • Hu D
        • et al.
        Molecular mechanisms of breast cancer metastasis by gene expression profile analysis.
        Mol Med Rep. 2017; 16: 4671-4677
        • Qu X
        • Tang Y
        • Hua S.
        Immunological approaches towards cancer and inflammation: a cross talk.
        Front Immunol. 2018; 9: 563
        • Khandia R
        • Munjal A.
        Interplay between inflammation and cancer.
        Adv Protein Chem Struct Biol. 2020; 119: 199-245
        • Aziz MH
        • Sideras K
        • Aziz NA
        • et al.
        The systemic-immune-inflammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study.
        Ann Surg. 2019; 270: 139-146
        • Sun Y
        • Zhang L.
        The clinical use of pretreatment NLR, PLR, and LMR in patients with esophageal squamous cell carcinoma: evidence from a meta-analysis.
        Cancer Manag Res. 2018; 10 (Published 2018 Nov 22): 6167-6179
        • Mandaliya H
        • Jones M
        • Oldmeadow C
        • Nordman II.
        Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI).
        Transl Lung Cancer Res. 2019; 8: 886-894
        • Yin X
        • Wu L
        • Yang H
        • et al.
        Prognostic significance of neutrophil-lymphocyte ratio (NLR) in patients with ovarian cancer: a systematic review and meta-analysis.
        Medicine (Baltimore). 2019; 98: e17475
        • Peng Y
        • Chen R
        • Qu F
        • et al.
        Low pretreatment lymphocyte/monocyte ratio is associated with the better efficacy of neoadjuvant chemotherapy in breast cancer patients.
        Cancer Biol Ther. 2020; 21: 189-196
        • Pacheco-Barcia V
        • Mondéjar Solís R
        • France T
        • et al.
        A systemic inflammation response index (SIRI) correlates with survival and predicts oncological outcome for mFOLFIRINOX therapy in metastatic pancreatic cancer.
        Pancreatology. 2020; 20: 254-264
        • Valero C
        • Pardo L
        • Sansa A
        • et al.
        Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma.
        Head Neck. 2020; 42: 336-343
        • Li S
        • Yang Z
        • Du H
        • Zhang W
        • Che G
        • Liu L
        Novel systemic inflammation response index to predict prognosis after thoracoscopic lung cancer surgery: a propensity score-matching study.
        ANZ J Surg. 2019; 89: E507-E513
        • Gao W
        • Zhang F
        • Ma T
        • et al.
        High preoperative fibrinogen and systemic inflammation response index (F-SIRI) predict unfavorable survival of resectable gastric cancer patients.
        J Gastric Cancer. 2020; 20: 202-211
        • Sandberg LJ
        • Clemens MW
        • Symmans WF
        • et al.
        molecular profiling using breast cancer subtype to plan for breast reconstruction.
        Plast Reconstr Surg. 2017; 139: 586e-596e
        • Hanahan D
        • Weinberg RA.
        Hallmarks of cancer: the next generation.
        Cell. 2011; 144: 646-674
        • Grivennikov SI
        • Greten FR
        • Karin M.
        Immunity, inflammation, and cancer.
        Cell. 2010; 140: 883-899
        • Walz W
        • Cayabyab FS.
        Neutrophil Infiltration and Matrix Metalloproteinase-9 in Lacunar Infarction.
        Neurochem Res. 2017; 42: 2560-2565
        • Tan KW
        • Chong SZ
        • Wong FH
        • et al.
        Neutrophils contribute to inflammatory lymphangiogenesis by increasing VEGF-A bioavailability and secreting VEGF-D.
        Blood. 2013; 122: 3666-3677
        • Laviron M
        • Combadière C
        • Boissonnas A.
        Tracking monocytes and macrophages in tumors with live imaging.
        Front Immunol. 2019; 10: 1201
        • Kiss M
        • Caro AA
        • Raes G
        • Laoui D.
        Systemic reprogramming of monocytes in cancer.
        Front Oncol. 2020; 10: 1399
        • Mohme M
        • Riethdorf S
        • Pantel K.
        Circulating and disseminated tumour cells - mechanisms of immune surveillance and escape.
        Nat Rev Clin Oncol. 2017; 14: 155-167
        • Kilinc MO
        • Rowswell-Turner RB
        • Gu T
        • et al.
        Activated CD8+ T-effector/memory cells eliminate CD4+ CD25+ Foxp3+ T-suppressor cells from tumors via FasL mediated apoptosis.
        J Immunol. 2009; 183: 7656-7660
        • Chen L
        • Kong X
        • Wang Z
        • Wang X
        • Fang Y
        • Wang J.
        Pretreatment systemic inflammation response index in patients with breast cancer treated with neoadjuvant chemotherapy as a useful prognostic indicator.
        Cancer Manag Res. 2020; 12 (Published 2020 Mar 3): 1543-1567
        • Hua X
        • Long ZQ
        • Huang X
        • et al.
        The preoperative systemic inflammation response index (SIRI) independently predicts survival in postmenopausal women with breast cancer.
        Curr Probl Cancer. 2020; 44100560
        • Wang L
        • Zhou Y
        • Xia S
        • et al.
        Prognostic value of the systemic inflammation response index (SIRI) before and after surgery in operable breast cancer patients.
        Cancer Biomark. 2020; 28: 537-547
        • Chen Z
        • Wang K
        • Lu H
        • et al.
        Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis.
        Cancer Manag Res. 2019; 11: 909-919
        • Geng Y
        • Zhu D
        • Wu C
        • Wu J
        • Wang Q
        • Li R
        • Jiang J
        • Wu C.
        A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma.
        Int Immunopharmacol. 2018;