The Gustave Roussy Immune score (GRIm score) as a novel prognostic score for early breast cancer patients: A real-world retrospective study

Abstract

Background and objective: The aim of this research is to investigate whether the GRIm score serves as a novel prognostic tool for predicting the survival rates among early breast cancer patients undergoing surgical treatment. Methods: This retrospective study included 313 cases of breast cancer patients hospitalized in our hospital from January 2015 to November 2015. All enrolled patients received surgery and had no metastasis. The GRIm score was based on five objective markers: (1) albumin level (<3.5 g/L = 1 point), (2) LDH level (≥245 U/L = 1 point); (3) AST-to-ALT ratio (≥1.44 = 1 point); (4) total bilirubin level (≥21 μmol/ml = 1 point); (5) NLR (≥1.51 = 1 point). The best critical value was 1.51 for NLR by ROC. Patients were categorized into two groups based on GRIm scores: low-score group (0 point) and high-score group (1 to 5 points). Kaplan-Meier method and log rank test were utilized to estimate disease free survival (DFS) and overall survival (OS). Both univariate analysis and multivariate Cox analysis were used to analyze the relationship among the enrolled parameters. Nomograms were formulated reliant on the outcomes of multivariate Cox analysis. Results: Based on the GRIm score, the cohort was divided into two groups: a low-score group with 81 cases and a high-score group with 232 cases. The mean DFS and OS were significantly prolonged in low-score group compared to high-score group (DFS: 74.39 vs. 66.20 months, χ²=8.729, P=0.0031; OS: 83.71 vs. 76.40 months, χ²=8.729, P=0.0031). According to multivariable analysis, GRIm score was notably correlated with DFS (HR: 2.789, 95% CI: 1.304-5.965, P= 0.004) and OS (HR: 3.015, 95% CI: 1.409-10.087, P=0.004). Nomograms exhibited excellent predictive performance for DFS (C-index: 0.823) and OS (C-index: 0.807). Conclusions: GRIm score serves as a predictive tool for assessing the prognosis of early breast cancer patients. Nomograms based on GRIm score show good prediction ability.

Keywords: Gustave Roussy immune score; NLR; breast cancer; lactate dehydrogenase; prognosis.