Prognostic Value of Immune-Inflammation Indexes for Breast Cancer Patients Undergoing Endocrine Therapy: A Systematic Review and Meta-analysis

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PURPOSE: Research suggests that systemic immune-inflammation index (SII), neutrophil lymphocyte (NLR), platelet lymphocyte (PLR) and lymphocyte monocyte (LMR) can act as potential prognostic indicators for breast cancer (BC). However, its prognostic value for BC patients undergoing endocrine therapy (ET) remains inconclusive. METHODS: We systematically searched Embase, Cochrane Library, PubMed, and Web of Science for studies on the prognostic significance of immune-inflammation indexes for BC patients undergoing ET from inception to May 5, 2024. Overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) were the primary outcomes, and they were statistically analyzed by hazard ratios (HR) with 95% confidence intervals (CI). Sensitivity and subgroup analyses were performed to explore the source of heterogeneity. STATA 15.1 and Review Manager 5.4 were adopted for data analyses. RESULTS: Fifteen studies with 27 cohorts of 3168 BC patients undergoing ET were included. The results showed that low NLR was associated with prolonged OS (HR = 2.19, 95% CI, 1.67-2.87; P < .00001) and PFS (HR = 1.64, 95% CI, 1.32-2.04; P < .00001) in overall BC patients receiving ET. High LMR was associated with longer OS (HR = 2.67, 95% CI, 1.64-4.33; P < .0001) in the overall BC patients undergoing ET. Low PLR was significantly associated with prolonged PFS (HR = 1.89, 95% CI, 1.40-2.55; P < .0001). Additionally, low PLR was associated with longer OS (HR = 2.16, 95% CI, 1.03-4.52, P = .04), but sensitivity analysis showed that its significance was not robust enough. All subgroup analyses revealed overall roboust results. CONCLUSION: Immune-inflammation indexes can potentially act as prognostic biomarkers for BC patients undergoing ET, contributing to wiser decision-making in BC treatment.