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. 2022 Mar 3;22(1):234.
doi: 10.1186/s12885-022-09312-x.

Prognostic significance of the skeletal muscle index and systemic inflammatory index in patients with lymph node-positive breast cancer after radical mastectomy

Ru Tang #  1 , Jia-Peng Deng #  1 , Lei Zhang #  1 , Wen-Wen Zhang  2 , Jia-Yuan Sun  1 , Feng Chi  1 , Jun Zhang  1 , San-Gang Wu  3 , Zhen-Yu He  4
Affiliations

Prognostic significance of the skeletal muscle index and systemic inflammatory index in patients with lymph node-positive breast cancer after radical mastectomy

Ru Tang et al. BMC Cancer. .

Abstract

Background: The role of skeletal muscle index (SMI) and systemic inflammation index (SII) for patients with lymph node-positive breast cancer remain controversial. This retrospective study aims to evaluate the individual and synergistic value of SMI and SII in outcomes prediction in this population.

Methods: Lymph node-positive breast cancer patients who received mastectomy between January 2011 and February 2013 were included in this retrospective study. We used abdominal computed tomography (CT) to measure skeletal muscle mass at the third lumbar (L3) level. The optimal cut-off values of SMI and SII were determined through maximizing the Youden index on the receiver operating characteristic (ROC) curves. Kaplan-Meier method was used to assess the correlation between SMI, SII, and overall survival (OS). The prognostic value of SMI and SII were analyzed with the multivariable Cox proportional hazards model.

Results: Of 97 patients included in our study (mean age: 46 [range: 27-73] years; median follow-up: 62.5 months), 71 had low SMI (sarcopenia), 59 had low SII, and 56 had low SMI + SII. Kaplan-Meier survival curves showed that both high SMI (P = 0.021, 5-year OS: 84.0% vs. 94.1%) and high SII (P = 0.043, 5-year OS: 81.0% vs. 97.3%) were associated with worse OS. Additionally, patients with either low SMI or low SII had significantly better OS (P = 0.0059, 5-year OS: 100.0% vs. 84.6%) than those with high SMI + SII. Multivariable analysis confirmed the predictive values of high SMI (P = 0.024, hazard ratio [HR]: 9.87) and high SII (P = 0.048, HR: 6.87) for poor OS. Moreover, high SMI + SII was significantly associated with poor survival (P = 0.016, HR: 16.36).

Conclusions: In this retrospective analysis, both SMI and SII independently predicted the prognosis of patients with lymph node-positive breast cancer. SMI + SII might be a stronger prognostic factor than either alone based on our findings, but should be further verified in a larger study.

Keywords: Breast cancer; Overall survival; Skeletal muscle index (SMI); Systemic inflammation index (SII).

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Body composition at the third lumbar vertebra level. Yellow: visceral adipose tissue (VAT); Pink: skeletal muscle mass (SMM); Orange: subcutaneous adipose tissue (SAT)
Fig. 2
Fig. 2
Kaplan–Meier curves indicating the overall survival (OS) rates of SMI (a), SII (b), and SMI + SII (c), respectively. SMI, skeletal muscle index; SII, systemic inflammation index
Fig. 3
Fig. 3
Cox proportional hazards models showing the correlation between clinical variables and overall survival (n = 97): Model A. PNI, prognostic nutritional index; SMI, skeletal muscle index; SII, systemic inflammation index
Fig. 4
Fig. 4
Cox proportional hazards models showing the correlation between clinical variables and overall survival (n = 97): Model B. PNI, prognostic nutritional index
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