Effect of systemic immune-inflammation index on prognostic parameters and survival in patients with breast cancer under the age of 40 years
Authors: Demir Hacer , Beypınar İsmail 
Published: January 2021

Objective: Systemic immune inflammation index, which is one of the systemic inflammatory markers obtained by using peripheral blood cells, neutrophils, lymphocyte and platelet counts, has been previously shown to be prognostic in many types of cancer, and it has been also shown in previous studies that SII was associated with prognosis in patients who received adjuvant and neoadjuvant therapy in breast cancer. In our study, the evaluation of the potential prognostic importance of SII in patients with breast cancer diagnosed before the age of 40 was aimed.
Material and method: For the study, demographic, histopathological, clinical and file data of 129 patients who were diagnosed with breast cancer in the tertiary medical oncology outpatient clinic and were 40 years old and younger at the time of diagnosis were recorded retrospectively. SII was calculated according to the neutrophil count x platelet number/lymphocyte (NxP / L) formula, and those below the optimal cut-off value obtained by ROC analysis were classified as low SII, and those above it as High SII. The relationship between breast cancer clinicopathological variables and SII was evaluated by Chi-Square test. While the effect of SII on survival was evaluated by Kaplan Meiermethod, the Logrank test was used to evaluate survival in low and high groups.
Results: For the study, 1400 patients diagnosed with breast cancer were reviewed and 129 patients who were under the age of 40 at the time of diagnosis were included. Patients who had insufficient follow-up or whose pre-treatment hemogram values could not be reached, who had medication use that could affect their hemogram parameters, and those with inflammatory diseases were not included. The median age in the study was 35, and the youngest patient was 21 years old. In the study group, based on the SII cut-off value of 720 calculated according to the roc analysis, 73 patients were in the low SII group and 56 patients were in the high SII group. When the relationship between prognostic factors of the patients and SII was examined, no statistically significant relationship was observed between age, hormone receptor status, Her-2 status, histological subtype, clinical stage, grade, Ki 67 status, lymph node involvement and SII. However, in the survival analysis, although the median value could not be reached between the two groups, there was a significant difference in overall survival with SII (p = 0.051) and it was observed that survival was worse in the high SII group, and the 3 and 5-year survival rates were worse in the high group compared to the low ones.
Conclusion: In our study, we reached the conclusion that SII can be an independent prognostic factor for survival in patients with breast cancer diagnosed at 40 years of age or younger. Considering the SII status together with other prognostic factors in diagnosis, a more intensive treatment plan can be made for the patients. However, well-designed prospective studies including more patients are needed for the routine use of SII.