ORIGINAL RESEARCH article
Front. Oncol.
Sec. Breast Cancer
Pan-Immune-Inflammation Value: Racial Variations and Differences in Prognostic Accuracy Across Breast Cancer Subtypes at a Single Institution
Indigo Johnson 1,2
Atif Bacchus 3
Ross Budziszewski 1
Scott Siegel 1
Jennifer Sims-Mourtada 1
1. Helen F Graham Cancer Center and Research Institute, Christiana Care Health System, Wilmington, United States
2. Philadelphia College of Osteopathic Medicine Department of Bio-Medical Sciences, Philadelphia, United States
3. University of Delaware, Newark, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Introduction: The Pan-Immune-Inflammatory-Value (PIV) has shown promise as a biomarker for predicting survival outcomes in breast cancer (BC) patients. This study explores the variation of PIV across BC subtypes, with a focus on triple-negative BC (TNBC), hormone receptor positive and negative (HR+ and HR-) cancers, and racial disparities in immune response. Methods: A retrospective review of laboratory and clinical data of 2,597 BC patients treated between 2012 – 2022 was conducted. PIV was calculated as a composite marker of neutrophils, monocytes, lymphocytes, and platelets. Comparative analysis of PIV with race, subtype and stage was performed using Man-Whitney. For categorical analysis of PIV, receiver operating characteristic curve was generated, and the optimal cutoff point was determined using the Youden index (cutoff = 395). Descriptive and inferential tests were used to compare high/low PIV groups based on race and BC subtype. Disease-free survival (DFS), and overall survival (OS) were evaluated with Kaplan-Meier curves and Cox regression analysis. Results: PIV varied significantly by race and subtype; Black women were significantly less likely to present with high PIV (OR = 0.595, 95% CI: 0.505 – 0.701) compared to White women. Lower values were also observed in Black women, TNBC patients and those with HR− tumors. Over a median follow-up of 55.4 months, high PIV was associated with worse DFS and OS in the overall cohort (p < 0.0005). Subgroup analysis showed high PIV predicted shorter DFS in both Black and White women but was not associated with OS in Black women or DFS in TNBC. In multivariable Cox regression, stage and PIV independently predicted DFS and OS. Significant interactions were observed between PIV and both race and subtype for breast cancer outcomes. Conclusion: While PIV shows promise as a general prognostic indicator, its predictive accuracy varies across different receptor subtypes. In HR+ BC patients, PIV is linked to clinical outcomes, supporting its role as a prognostic biomarker. However, further research is needed to assess the use of PIV as a prognostic biomarker.
Summary
Keywords
breast cancer, pan-immune-inflammatory value, prognostic biomarker, Racial Disparities, systemic inflammation, Triple-negative breast cancer
Received
28 August 2025
Accepted
19 February 2026
Copyright
© 2026 Johnson, Bacchus, Budziszewski, Siegel and Sims-Mourtada. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jennifer Sims-Mourtada
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.