World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 15, Number 6, December 2024, pages 942-949

Clinicopathological Factors and Interleukin-6 Levels Associated With Low Relative Dose Intensity in Women With Breast Cancer Receiving First-Line Chemotherapy

Figure 1. Flowchart of subjects’ inclusion. From 245 patients in the main study, 73 patients were excluded due to not receiving chemotherapy, receiving less than 3 chemotherapy cycles, not having 3-weekly chemotherapy regimen, incomplete clinical data, and unavailability of stored blood sample. A total of 172 patients with stage I-IV BC were included for analysis.

**Table 1.** Baseline Characteristics (N = 172)
Variables	Frequency (%)
SD: standard deviation; ER: estrogen receptor; PR: progesterone receptor; HER2: human epidermal growth factor receptor 2; AC-T: anthracycline/cyclophosphamide followed by taxane; AC: anthracycline/cyclophosphamide; AC-TH: anthracycline/cyclophosphamide followed by taxane and trastuzuma; T: taxane.
Age (years, mean ± SD)	52.07 ± 9.03
≤ 60 years	141 (82.0)
> 60 years	31 (18.0)
Body mass index (kg/m², mean ± SD)	23.94 ± 4.42
≥ 23 kg/m²	96 (55.8)
< 23 kg/m²	76 (44.2)
Comorbidity presence
No	73 (42.4)
Yes	99 (57.6)
Diabetes mellitus comorbidity
No	152 (88.4)
Yes	20 (11.6)
Hypertension comorbidity
No	132 (76.7)
Yes	40 (23.3)
Cancer stage
Stage I-II	52 (30.2)
Stage III-IV	120 (69.8)
ER, PR, HER2 status
ER⁺ or PR⁺, HER2^-	85 (49.4)
HER2⁺	55 (32.0)
ER^-, PR^-, HER2^-	32 (18.6)
Chemotherapy setting
Adjuvant/neoadjuvant	133 (77.3)
Palliative	39 (22.7)
Chemotherapy regimen
AC	18 (10.5)
T	25 (14.5)
AC-T	123 (71.5)
Other (capecitabine)	6 (3.5)
Pre-treatment laboratory parameters
Glucose (mg/dL, mean ± SD)	114.04 ± 35.94
Albumin (g/dL, mean ± SD)	4.30 ± 0.56
Vitamin D (ng/mL, mean ± SD)	9.19 ± 4.14

Table 1. Baseline Characteristics (N = 172)

Variables

Frequency (%)

SD: standard deviation; ER: estrogen receptor; PR: progesterone receptor; HER2: human epidermal growth factor receptor 2; AC-T: anthracycline/cyclophosphamide followed by taxane; AC: anthracycline/cyclophosphamide; AC-TH: anthracycline/cyclophosphamide followed by taxane and trastuzuma; T: taxane.

Age (years, mean ± SD)

52.07 ± 9.03

≤ 60 years

141 (82.0)

> 60 years

31 (18.0)

Body mass index (kg/m², mean ± SD)

23.94 ± 4.42

≥ 23 kg/m²

96 (55.8)

< 23 kg/m²

76 (44.2)

Comorbidity presence

73 (42.4)

Yes

99 (57.6)

Diabetes mellitus comorbidity

152 (88.4)

Yes

20 (11.6)

Hypertension comorbidity

132 (76.7)

Yes

40 (23.3)

Cancer stage

Stage I-II

52 (30.2)

Stage III-IV

120 (69.8)

ER, PR, HER2 status

ER⁺ or PR⁺, HER2^-

85 (49.4)

HER2⁺

55 (32.0)

ER^-, PR^-, HER2^-

32 (18.6)

Chemotherapy setting

Adjuvant/neoadjuvant

133 (77.3)

Palliative

39 (22.7)

Chemotherapy regimen

18 (10.5)

25 (14.5)

AC-T

123 (71.5)

Other (capecitabine)

6 (3.5)

Pre-treatment laboratory parameters

Glucose (mg/dL, mean ± SD)

114.04 ± 35.94

Albumin (g/dL, mean ± SD)

4.30 ± 0.56

Vitamin D (ng/mL, mean ± SD)

9.19 ± 4.14

**Table 2.** Clinicopathological and Pro-Inflammatory Factors Associated With RDI < 85%
Variables	RDI < 85% (n = 23)	RDI ≥ 85% (n = 149)	Crude OR	95% CI	P value	Adjusted OR	95% CI	P value
*P < 0.05. RDI: relative dose intensity; OR: odds ratio; 95% CI: 95% confidence interval; ER: estrogen receptor; PR: progesterone receptor; HER2: human epidermal growth factor receptor 2; AC-T: anthracycline/cyclophosphamide followed by taxane; CRP: C-reactive protein.
Age
≤ 60 years	17 (73.9)	124 (83.2)	Ref
> 60 years	6 (26.1)	25 (16.8)	1.75	0.63 - 4.88	0.284
Body mass index
≥ 23 kg/m²	10 (43.5)	86 (57.7)	Ref			Ref
< 23 kg/m²	13 (56.5)	63 (42.3)	1.77	0.73 - 4.30	0.205	1.77	0.59 - 5.36	0.310
Comorbidity presence
No	7 (30.4)	66 (44.3)	Ref			Ref
Yes	16 (69.6)	83 (55.7)	1.82	0.71 - 4.68	0.215	0.87	0.25 - 2.96	0.820
Diabetes mellitus
No	16 (69.6)	136 (91.3)	Ref			Ref
Yes	7 (30.4)	13 (8.7)	4.58	1.59 - 13.14	0.005	4.78	1.03 - 22.27	0.046*
Hypertension
No	17 (73.9)	115 (77.2)	Ref
Yes	6 (26.1)	34 (22.8)	1.19	0.44 - 3.26	0.730
Cancer stage
Stage I-II	4 (17.4)	48 (32.2)	Ref			Ref
Stage III-IV	19 (82.6)	101 (67.8)	2.26	0.73 - 6.99	0.158	1.03	0.24 - 4.45	0.964
ER, PR, HER2 status
ER⁺ or PR⁺, HER2^-	9 (39.1)	76 (51.0)	Ref			Ref
HER2⁺	8 (34.8)	47 (31.5)	1.44	0.52 - 3.98	0.485	1.64	0.46 - 5.87	0.447
ER^-, PR^-, HER2^-	6 (26.1)	36 (17.5)	1.95	0.63 - 6.00	0.245	6.45	1.39 - 29.83	0.017*
Chemotherapy setting
Adjuvant/neoadjuvant	12 (52.2)	121 (81.2)	Ref			Ref
Palliative	11 (47.8)	28 (18.8)	3.96	1.58 - 9.89	0.003	2.49	0.61 - 10.12	0.203
Chemotherapy regimen
AC-T	14 (60.9)	109 (73.2)	Ref			Ref
Other	9 (39.1)	40 (26.8)	1.75	0.70 - 4.36	0.228	0.99	0.29 - 3.39	0.986
Glucose
≤ 105.5 mg/dL	8 (40.0)	73 (54.5)	Ref			Ref
> 105.5 mg/dL	12 (60.0)	61 (45.5)	1.79	0.69 - 4.67	0.231	0.99	0.29 - 3.39	0.986
Albumin
≥ 4.4 g/dL	7 (31.8)	78 (52.4)	Ref			Ref
< 4.4 g/dL	15 (68.2)	71 (47.6)	2.35	0.91 - 6.10	0.078	2.19	0.59 - 8.04	0.239
Vitamin D
≥ 8.6 ng/mL	14 (60.9)	74 (49.7)	Ref
< 8.6 ng/mL	9 (39.1)	75 (50.3)	0.63	0.26 - 1.55	0.320
CRP
≤ 5 mg/L	10 (43.5)	75 (50.3)	Ref
> 5 mg/L	13 (56.5)	74 (49.7)	1.32	0.54 - 3.19	0.541
IL-6
≤ 0.5 pg/mL	12 (52.2)	125 (83.9)	Ref			Ref
> 0.5 pg/mL	11 (47.8)	24 (16.1)	4.77	1.89 - 12.07	0.001	3.45	1.01 - 11.79	0.049*

Table 2. Clinicopathological and Pro-Inflammatory Factors Associated With RDI < 85%

Variables

RDI < 85% (n = 23)

RDI ≥ 85% (n = 149)

Crude OR

95% CI

P value

Adjusted OR

95% CI

P value

*P < 0.05. RDI: relative dose intensity; OR: odds ratio; 95% CI: 95% confidence interval; ER: estrogen receptor; PR: progesterone receptor; HER2: human epidermal growth factor receptor 2; AC-T: anthracycline/cyclophosphamide followed by taxane; CRP: C-reactive protein.

Age

≤ 60 years

17 (73.9)

124 (83.2)

Ref

> 60 years

6 (26.1)

25 (16.8)

1.75

0.63 - 4.88

0.284

Body mass index

≥ 23 kg/m²

10 (43.5)

86 (57.7)

Ref

< 23 kg/m²

13 (56.5)

63 (42.3)

1.77

0.73 - 4.30

0.205

1.77

0.59 - 5.36

0.310

Comorbidity presence

7 (30.4)

66 (44.3)

Ref

Yes

16 (69.6)

83 (55.7)

1.82

0.71 - 4.68

0.215

0.87

0.25 - 2.96

0.820

Diabetes mellitus

16 (69.6)

136 (91.3)

Ref

Yes

7 (30.4)

13 (8.7)

4.58

1.59 - 13.14

0.005

4.78

1.03 - 22.27

0.046*

Hypertension

17 (73.9)

115 (77.2)

Ref

Yes

6 (26.1)

34 (22.8)

1.19

0.44 - 3.26

0.730

Cancer stage

Stage I-II

4 (17.4)

48 (32.2)

Ref

Stage III-IV

19 (82.6)

101 (67.8)

2.26

0.73 - 6.99

0.158

1.03

0.24 - 4.45

0.964

ER, PR, HER2 status

ER⁺ or PR⁺, HER2^-

9 (39.1)

76 (51.0)

Ref

HER2⁺

8 (34.8)

47 (31.5)

1.44

0.52 - 3.98

0.485

1.64

0.46 - 5.87

0.447

ER^-, PR^-, HER2^-

6 (26.1)

36 (17.5)

1.95

0.63 - 6.00

0.245

6.45

1.39 - 29.83

0.017*

Chemotherapy setting

Adjuvant/neoadjuvant

12 (52.2)

121 (81.2)

Ref

Palliative

11 (47.8)

28 (18.8)

3.96

1.58 - 9.89

0.003

2.49

0.61 - 10.12

0.203

Chemotherapy regimen

AC-T

14 (60.9)

109 (73.2)

Ref

Other

9 (39.1)

40 (26.8)

1.75

0.70 - 4.36

0.228

0.99

0.29 - 3.39

0.986

Glucose

≤ 105.5 mg/dL

8 (40.0)

73 (54.5)

Ref

> 105.5 mg/dL

12 (60.0)

61 (45.5)

1.79

0.69 - 4.67

0.231

0.99

0.29 - 3.39

0.986

Albumin

≥ 4.4 g/dL

7 (31.8)

78 (52.4)

Ref

< 4.4 g/dL

15 (68.2)

71 (47.6)

2.35

0.91 - 6.10

0.078

2.19

0.59 - 8.04

0.239

Vitamin D

≥ 8.6 ng/mL

14 (60.9)

74 (49.7)

Ref

< 8.6 ng/mL

9 (39.1)

75 (50.3)

0.63

0.26 - 1.55

0.320

CRP

≤ 5 mg/L

10 (43.5)

75 (50.3)

Ref

> 5 mg/L

13 (56.5)

74 (49.7)

1.32

0.54 - 3.19

0.541

IL-6

≤ 0.5 pg/mL

12 (52.2)

125 (83.9)

Ref

> 0.5 pg/mL

11 (47.8)

24 (16.1)

4.77

1.89 - 12.07

0.001

3.45

1.01 - 11.79

0.049*