Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer

Abstract

BackgroundTo build a predictive scoring model based on simple immune and inflammatory parameters to predict postoperative survival in patients with breast cancer.MethodsWe used a brand-new immuno-inflammatory index—pan-immune-inflammation value (PIV)—to retrospectively evaluate the relationship between PIV and overall survival (OS), and based on the results of Cox regression analysis, we established a simple scoring prediction model based on several independent prognostic parameters. The predictive accuracy of the model was evaluated and independently validated.ResultsA total of 1,312 patients were included for analysis. PIV was calculated as follows: neutrophil count (109/L) × platelet count (109/L) × monocyte count (109/L)/lymphocyte count (109/L). According to the best cutoff value of PIV, we divided the patients into two different subgroups, high PIV (PIV > 310.2) and low PIV (PIV ≤ 310.2), associated with significantly different survival outcomes (3-year OS, 80.26% vs. 86.29%, respectively; 5-year OS, 62.5% vs. 71.55%, respectively). Six independent prognostic factors were identified and used to build the scoring system, which performed well with a concordance index (C-index) of 0.759 (95% CI: 0.715–0.802); the calibration plot showed good calibration.ConclusionsWe have established and verified a simple scoring system for predicting prognosis, which can predict the survival of patients with operable breast cancer. This system can help clinicians implement targeted and individualized treatment strategies.

The Association between the Pan-Immune-Inflammation Value and Cancer Prognosis: A Systematic Review and Meta-Analysis

“…Fifteen studies encompassing 4942 patients were included in the meta-analyses [ 32 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The available studies were conducted on several tumors, including CRC, melanoma, breast cancer, and non-small cell lung cancer ( Table 1 ).…”

“…Additionally, one study included a basket cohort consisting of several types of tumors treated with immunotherapy [ 39 ]. The sample sizes varied between 49 [ 43 ] and 1312 [ 47 ], and the PIV cut-offs ranged from 285 [ 41 ] to 600 [ 37 ]. Median levels, receptor operating characteristics (ROC), and maximally selected rank statistics were used in each of the five studies.…”

“…One study evaluated both patients treated with immunotherapy (nivolumab and pembrolizumab alone) and targeted therapy with BRAF inhibitors/MEK inhibitors, and separate data for these treatment types were included in the subgroup analyses [ 32 ]. Ten studies included Caucasian patients [ 32 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 48 ], while five studies were conducted in the Far East [ 44 , 45 , 46 , 47 , 49 ]. Most studies had a low risk of bias according to the NOS ( Table 2 ).…”

“…A trend toward an association with worse PFS was only observed with the PIV score as the prognostic index in multivariate analyses [ 41 ]. Recently, Lin et al evaluated the efficacy of PIV with the typical TNM staging method in predicting prognosis in patients with breast cancer and found that PIV was more accurate in predicting OS than the traditional TNM staging system, thus emphasizing PIV’s clinical utility [ 47 ] As a result, it is considered that the PIV formula, which uses the counts of four types of blood cells (i.e., monocytes, neutrophils, platelets, and lymphocytes), might provide a more consistent and accurate prediction of poor prognosis than the previously recommended indices. Further research with the models incorporating the other CBC-based indexes with PIV is eagerly awaited to delineate the possible superiority of PIV over other CBC-based biomarkers.…”

Prognostic Potential of Immune Inflammatory Biomarkers in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

“…Moreover, despite the NLR being the most commonly analyzed parameter of systemic inflammation, biomarkers that take into account platelets and monocytes deserve attention, as they have shown potential relevance [ 18 , 19 ]. Recently, the pan-immune inflammation value (PIV) has been reported as a new comprehensive biomarker involving the neutrophil, platelet, monocyte, and lymphocyte counts, with the claim to perform better than single immune inflammatory indicators in predicting survival outcomes [ 20 , 21 ]. However, a current limitation to the everyday use of blood cell-based biomarkers is the fact that there are no homogenous cutoffs since studies conducted on diverse populations around the globe yield different reference values.…”