Characteristics of Inflammatory Cytokines and Prognostic Predictive Value in Breast Cancer Patients with Sleep Disorders

Xiuhong ZHANG; Gaijun ZHU; Lihui DONG

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Xiuhong ZHANG, Gaijun ZHU, Lihui DONG. Characteristics of Inflammatory Cytokines and Prognostic Predictive Value in Breast Cancer Patients with Sleep Disorders[J]. Journal of Kunming Medical University.

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Xiuhong ZHANG, Gaijun ZHU, Lihui DONG. Characteristics of Inflammatory Cytokines and Prognostic Predictive Value in Breast Cancer Patients with Sleep Disorders[J]. Journal of Kunming Medical University.

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Characteristics of Inflammatory Cytokines and Prognostic Predictive Value in Breast Cancer Patients with Sleep Disorders

1.
Department of Medical Oncology，Taiyuan Central Hospital，Taiyuan Shanxi 030009
2.
Department of Neurology，Taiyuan Central Hospital，Taiyuan Shanxi 030009，China

Received Date: 2026-02-02

Abstract

Abstract

Objective To explore the characteristics of serum inflammatory cytokine levels in breast cancer patients with sleep disorders and their prognostic predictive value for neoadjuvant chemotherapy combined with immunotherapy. Methods A total of 397 patients with hormone receptor-negative or HER2-negative breast cancer who were admitted to the Department of Oncology, Taiyuan Central Hospital, from May 2020 to May 2023 were retrospectively enrolled. Among them, 312 patients admitted between May 2020 and May 2022 served as the modeling set, and 85 patients admitted between June 2022 and May 2023 served as the temporal validation set. All patients underwent the Pittsburgh Sleep Quality Index （PSQI） assessment and serum inflammatory cytokine detection within 1 week after breast cancer diagnosis and before initiation of neoadjuvant chemotherapy combined with immunotherapy, followed by surgical treatment. Sleep disorders were evaluated according to PSQI scores, and patients were followed up for 2 years to assess prognosis. The levels of inflammatory cytokine were compared among patients with different sleep statuses and varying severities of sleep disorders. Risk factors associated with poor prognosis were identified, and a prognostic prediction model was developed. The performance of the model was evaluated using receiver operating characteristic （ROC） curves, calibration curves, the Hosmer–Lemeshow （H-L） goodness-of-fit test, and decision curve analysis （DCA）. Results Serum IL-1β, IL-6, IL-8 and TNF-α levels in the breast cancer sleep disorder group were significantly higher than those without sleep disorders, while IFN-γ levels were lower than those in patients without sleep disorders（P < 0.05）. The severe sleep disorder group had higher IL-1β, IL-6, IL-8, and TNF-α levels and lower IFN-γ levels than the moderate and mild groups, （P < 0.05）. The poor prognosis group had higher proportions of clinical stage III disease and anxiety/depression, higher PSQI scores, higher IL-1β, IL-6, IL-8, and TNF-α levels, and lower IFN-γ levels compared with the good prognosis group（P < 0.05）. After adjusting for clinical stage and anxiety/depression status, multivariate logistic regression showed that clinical stage, anxiety/depression, PSQI score, and levels of IL-1β, IL-6, IL-8, TNF-α, and IFN-γ were independent factors for poor prognosis in breast cancer patients （P < 0.05）. The original AUC of the combined detection of the five inflammatory cytokines combined for predicting poor prognosis in breast cancer patients was 0.793, which was significantly higher than that of single detection （Z = 3.388, 3.268, 3.708, 4.439, 3.390, P < 0.05）. After adjusting for clinical stage and anxiety/depression, the adjusted AUC was 0.789. The internal validation AUC of the nomogram model was 0.79（95%CI: 0.70-0.88）, and the time-validation set AUC was 0.78（95%CI: 0.67-0.89）. The calibration curve showed good agreement well with the ideal curve. In the three pathological subgroups, the trends of inflammatory cytokine changes was consistent, and the combined AUCs ranged from 0.776 to 0.801, with no significant differences between subgroups（P > 0.05）. Conclusion Breast cancer patients with sleep disorders have elevated serum IL-1β, IL-6, IL-8, and TNF-α levels and decreased IFN-γ levels. An early warning model for poor prognosis in breast cancer patients with sleep disorders constructed based on these indicators has predictive value.
- Breast cancer,
- Sleep disorders,
- Inflammatory factor spectrum,
- Immunotherapy,
- Poor prognosis,
- Predictive value

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