Inflammatory scores are not interchangeable during the perioperative period of breast cancer surgery

Introduction:Inflammatory biomarkers and scores are important prognostic factors in breast cancer,and are proposed during the perioperative period. Here, we investigate their correlation and concor-dance in breast cancer surgical patients.Patients and methods: With the IRB approval and written informed consent, we included 14 patients (median age: 61 [41 to 82] years) scheduled for conservative surgery (n¼12) or mastectomy (n¼2) for breast cancer. We measured, at baseline, dayþ1 and dayþ8,albumin (Alb), C-Reactive Protein (CRP), total white blood cell counts (WBC), lymphocytes (L) and neutrophils (N) counts, and calculated the following inflammatory scores: Neutrophil-to-lymphocyteratio (NLR), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI) and Prognostic Nutri-tional Index (PNI). A linear regression model is used to compare CRP and NLR, and the Kappa statistic to detect discordance (<0) or agreement (>0.4) between the scores .Results: We measured 170 laboratory values and calculated 182 inflammatory scores. CRP, WBC, N and NLR are significantly different at dayþ1compared with baseline (respectively, at baseline, dayþ1 and dayþ8 (median[IQR 25e75]): CRP: 0.1[0.1e0.6], 0.85[0.2e1.18], 0.18[0.1e0.4]mg/dL; WBC: 6.36[5.91e7.16], 7.45[6.38e8.16], 7.73[6.25e8.54]103/mm3; N: 3.78[3.21e4.2], 5.05[4.37e5.99]103/mm3; and NLR: 1.95[1.67e2.46], 2.62[2.36e3.73], 2.23[1.46e2.43]) (P<0.05 for all the comparisons between baseline and dayþ1). Alb and L tend to decrease(P¼0.06). Discordance is clear between all the inflammatory scores (NLR, mGPS, PI, PNI) (Kappa<0).Conclusion:Inflammatory biomarkers and scores, like CRP, WBCs, N, NLR, PNI, and PI are modified after a breast cancer surgery, but with discordance and no interchangeability