A Novel Inflammatory and Nutritional Prognostic Scoring System for Nonpathological Complete Response Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy

Abstract

Background. It has been demonstrated that inflammatory and nutritional variables are associated with poor breast cancer survival. However, some studies do not include these variables due to missing data. To investigate the predictive potential of the INPS, we constructed a novel inflammatory-nutritional prognostic scoring (INPS) system with machine learning. Methods. This retrospective analysis included 249 patients with malignant breast tumors undergoing neoadjuvant chemotherapy (NAC). After comparing seven potent machine learning models, the best model, Xgboost, was applied to construct an INPS system. K-M survival curves and the log-rank test were employed to determine OS and DFS. Univariate and multivariate analyses were carried out with the Cox regression model. Additionally, we compared the predictive power of INPS, inflammatory, and standard nutritional variables using the $Z$ test. Results. After comparing seven machine learning models, it was determined that the XGBoost model had the best OS and DFS performance ( $\text{AUC}=0.865\text{and}0.771$ , respectively). For overall survival (OS, $\text{cutoff}\text{value}=0.3917$ ) and disease-free survival ( $\text{cutoff}\text{value}=0.4896$ ), all patients were divided into two groups by the INPS. Those with low INPS had higher 5-year OS and DFS rates (77.2% vs. 50.0%, $P<0.0001$ ; and 59.6% vs. 32.1%, $P<0.0001$ , respectively) than patients with high INPS. For OS and DFS, the INPS exhibited the highest AUC compared to the other inflammatory and nutritional variables ( $\text{AUC}=0.615$ , $P=0.0003$ ; $\text{AUC}=0.596$ , $P=0.0003$ , respectively). Conclusion. The INPS was an independent predictor of OS and DFS and exhibited better predictive ability than BMI, PNI, and MLR. For patients undergoing NAC for nonpCR breast cancer, INPS was a crucial and comprehensive biomarker. It could also forecast individual survival in breast cancer patients with low HER-2 expression.