title: Inflammatory scores are not interchangeable during the perioperative period of breast cancer surgery.
abstract: BACKGROUND
  Inflammatory biomarkers and scores are important prognostic factors in breast cancer, and are proposed during the perioperative period. Here, we investigate their correlation and concordance in breast cancer surgical patients.
  
  
  METHODS
  With the IRB approval and written informed consent, we included 14 patients (median age: 61 [41 to 82] years) scheduled for conservative surgery (n = 12) or mastectomy (n = 2) for breast cancer. We measured, at baseline, day+1 and day+8, 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-lymphocyte ratio (NLR), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI) and Prognostic Nutritional 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 day+1 compared with baseline (respectively, at baseline, day+1 and day+8 (median[IQR 25-75]): CRP: 0.1[0.1-0.6], 0.85[0.2-1.18], 0.18[0.1-0.4]mg/dL; WBC: 6.36[5.91-7.16], 7.45[6.38-8.16], 7.73[6.25-8.54] × 10(3)/mm(3); N: 3.78[3.21-4.2], 5.05[4.37-5.99] × 10(3)/mm(3); and NLR: 1.95[1.67-2.46], 2.62[2.36-3.73], 2.23[1.46-2.43]) (P < 0.05 for all the comparisons between baseline and day+1). Alb and L tend to decrease (P = 0.06). Discordance is clear between all the inflammatory scores (NLR, mGPS, PI, PNI) (Kappa<0).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. Electronic address: forgetpatrice@yahoo.fr.
authors.forename: Patrice
authors.initials: P
authors.lastname: Forget
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rengger
authors.affiliation: Department of Gynecology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Berliere
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: De Kock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood* / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D007958:Leukocyte Count; D016014:Linear Models; D008214:Lymphocytes / Q000166:cytology; D008408:Mastectomy; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D059035:Perioperative Period; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: Cancer; Inflammatory scores