Enhanced predictive value of post-treatment lymphocyte-based immunoinflammatory biomarkers for cancer therapy–related cardiac dysfunction in anthracycline-treated breast cancer patients

Cancer therapy–related cardiac dysfunction (CTRCD) is a major cardiovascular complication in breast cancer patients receiving anthracycline-based chemotherapy, with the systemic inflammatory response playing a pivotal role in its pathogenesis. The association between lymphocyte-based immunoinflammatory biomarkers and CTRCD remains incompletely elucidated, particularly regarding the predictive value of dynamic changes in these indices. This study aimed to investigate the predictive value of lymphocyte-based immunoinflammatory biomarkers for CTRCD in breast cancer patients undergoing anthracycline treatment. We retrospectively collected clinical data from breast cancer patients treated with anthracycline-based chemotherapy and conducted follow-up to monitor the development of CTRCD. Routine blood tests were performed pre- and post-anthracycline therapy, and seven lymphocyte-based immunoinflammatory indices (NLR, MLR, NMLR, SIRI, PLR, SII, PIV) were calculated accordingly. Receiver operating characteristic (ROC) curve analysis was used to compare the predictive value of these indices for CTRCD, while Kaplan-Meier curves and Cox regression analysis were performed for survival and risk factor assessment. A total of 75 patients were enrolled and followed up for a median of 27 months, with CTRCD observed in 9 (12%) cases. Lymphocyte-based immunoinflammatory biomarker levels were significantly elevated after anthracycline therapy. ROC curve analysis showed that post-treatment immunoinflammatory biomarkers had significantly higher predictive value for CTRCD than pre-treatment indices, with the AUCs of post-treatment MLR, NMLR, SIRI, SII, and PIV were 0.812, 0.828, 0.889, 0.803, 0.854 respectively. Additionally, post-treatment MLR, NMLR, SIRI, SII and PIV correlated significantly and positively with LVEF reduction at the 12th month, with correlation coefficients (r values) of 0.517 (P < 0.001), 0.552 (P < 0.001), 0.594 (P < 0.001), 0.415 (P < 0.001) and 0.559 (P < 0.001), respectively. Kaplan-Meier survival analysis revealed that patients with elevated post-treatment levels of these indices had a significantly increased risk of CTRCD. Multivariate Cox regression analysis further confirmed that post-treatment MLR (HR = 18.747, 95% CI = 1.871-187.799, p = 0.013), SIRI (HR = 2.877, 95% CI = 1.243–6.659, p = 0.014), and PIV (HR = 1.007, 95% CI = 1.002–1.012, p = 0.011) were independent predictors of CTRCD. Lymphocyte-based immunoinflammatory biomarkers assessed post-anthracycline therapy exhibit robust predictive value for CTRCD, with MLR, SIRI, and PIV serving as independent predictors of CTRCD in breast cancer patients receiving anthracycline-based chemotherapy.