Preoperative systemic inflammation response index: Clinicopathologic predictor of pathological complete response in HER2-positive breast cancer patients receiving neoadjuvant systemic therapy

Q: Which pretreatment systemic inflammatory marker was most significantly associated with pathological complete response?

Among the evaluated pretreatment systemic inflammatory markers, only the systemic inflammation response index (SIRI) showed a significant relationship with pathological complete response.

Q: What cutoff value for SIRI was identified in the study?

The study reported an optimal SIRI cutoff value of 1.27 × 10^9/L.

Q: How did SIRI relate to long-term outcomes in HER2-positive breast cancer patients?

Patients with SIRI < 1.27 had longer disease-free survival and overall survival based on Kaplan-Meier analysis.

Sep 29, 2026

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Background: Multiple pretreatment systemic inflammatory markers have been reported as predictors of pathological complete response after neoadjuvant systemic therapy in breast cancer, but the most significant marker and subtype variation remain unclear. Methods: This retrospective study analyzed 240 stage I–III HER2-positive patients, using stepwise logistic regression with backward selection to build a pCR nomogram. Results: SIRI was independently associated with pCR and showed good discrimination and calibration; lower SIRI corresponded to better DFS and OS. Conclusion: Pretreatment SIRI < 1.27 predicts pCR, DFS, and OS and supports clinical decision-making.

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J Chin MedAssoc Original article Preoperative systemic inflammation response index: Clinicopathologic predictor of pathological complete response in HER2-positive breast cancer patients receiving neoadjuvant systemic therapy Hong-Yu Wua, Chin-Yao Linb, Yen-Dun Tzenga,c, Chih-Chiang Hungd,e, Shiuh-Inn Liua,f, Chun-Hao Ying,h, Jin-Shuen Cheni, Yao-Shen Cheni, Jie-Ru Yangd,* aDepartment of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; bDepartment of Surgery, Breast Medical Center, Taichung Tzu Chi Hospital, Taichung, Taiwan, ROC; cInstitute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC; dDepartment of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; eDepartment of Applied Cosmetology, College of Human Science and Social Innovation, Hungkuang University, Taichung, Taiwan, ROC; fSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; gDepartment of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; hInstitute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC; iDepartment of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC Abstract Background: Multiple pretreatment systemic inflammatory markers (SIMs) have been reported as predictors of pathological complete response (pCR) after neoadjuvant systemic therapy (NST) in patients with breast cancer (BC) . However, the most significant SIM remains to be conclusively identified, and variations among different molecular subtypes remain unknown. The objective of the study was to identify the most significant SIM in patients with human epidermal growth factor receptor 2 (HER2) positive BC, to construct a pCR-predictive nomogram combining it with other clinicopathologic factors, and to evaluate its prognostic value on survival. Methods: We retrospectively reviewed the findings for 240 patients with stage I-III HER2-positive BC who underwent NST and subsequent surgery at Kaohsiung and Taichung Veterans General Hospital from 2011 to 2021. Clinicopathologic factors were analyzed by stepwise logistic regression with backward selection. The data were used to construct a nomogram plot for determining the pCR probability. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival (DFS) and overall survival (OS) . Results: Among the pretreatment SIMs, only the systemic inflammation response index (SIRI) was significantly related to pCR, with an optimal cutoff value of 1.27 × 109/L. Stepwise logistic analyses indicated that clinical N stage, HER2 immunohistochemistry score, hormone receptor status, targeted therapy regimen, and SIRI were independent predictors of pCR, with an area under the curve of 0.722. The Hosmer-Lemeshow test and calibration curve revealed that the predictive ability was a good fit to actual observations. A nomogram was constructed based on the logistic model. The external validation of the model also revealed satisfactory discrimination and calibration. Kaplan-Meier analysis showed that patients with SIRI <1 .27 had longer DFS and OS. Conclusion: Pretreatment SIRI <1 .27 is predictive of pCR, DFS, and OS in HER2-positive BC. Our nomogram could efficiently predict pCR and facilitate clinical decision-making before neoadjuvant treatment. Keywords: Breast neoplasms; Neoadjuvant therapy; Nomograms 1. INTRODUCTION Neoadjuvant systemic therapy (NST) is increasingly being used for treating early-stage breast cancer (BC) . It not only improves * Address correspondence. Dr. Jie-Ru Yang, Department of Surgery, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Taichung 407, Taiwan, [ROC. E-mail address: grace81916@yahoo.com.tw](ROC. E-mail address: grace81916@yahoo.com.tw) (J.-R. Yang). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed

FAQs

Which pretreatment systemic inflammatory marker was most significantly associated with pathological complete response?

Among the evaluated pretreatment systemic inflammatory markers, only the systemic inflammation response index (SIRI) showed a significant relationship with pathological complete response.

What cutoff value for SIRI was identified in the study?

The study reported an optimal SIRI cutoff value of 1.27 × 10^9/L.

How did SIRI relate to long-term outcomes in HER2-positive breast cancer patients?

Patients with SIRI < 1.27 had longer disease-free survival and overall survival based on Kaplan-Meier analysis.

Sep 29, 2026

Uploaded by Ivy