PIV, PNI and HALP score for predicting pathological complete response in breast cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis.

OBJECTIVE

This study sought to evaluate the associations of prognostic nutritional index (PNI), pan-immune-inflammation value (PIV), and hemoglobin, albumin, lymphocyte, platelet (HALP) score with the pathological complete response (pCR) in breast cancer (BC) patients undergoing neoadjuvant chemotherapy (NAC) and their diagnostic value.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science were systematically searched to identify eligible studies published up to October 2025. All types of studies examining the associations of PNI, PIV, and HALP with pCR following NAC in patients with BC were retrieved.

RESULTS

A total of 20 studies were included, 7 on PIV, 8 on PNI, and 5 on HALP. The meta-analysis pooling data from univariate regression analyses showed that low PIV (odds ratio [OR] = 1.962, 95% confidence interval [CI] 1.232-3.125, PZ = 0.005) and high PNI (OR = 2.129, 95% CI 1.412-3.210, PZ = 0.000) were markedly associated with pCR in patients with BC receiving NAC, while HALP was not associated with post-NAC pCR in patients with BC (OR = 1.573, 95% CI 0.890-2.779, PZ = 0.119). The meta-analysis pooling data from multivariate regression analyses showed that low PIV (OR = 2.018, 95% CI 1.567-2.597, PZ = 0.000), high PNI (OR = 2.206, 95% CI 1.330-3.661, PZ = 0.002), and high HALP (OR = 2.081, 95% CI 1.595-2.717, PZ = 0.000) were markedly linked to post-NAC pCR in BC patients. The diagnostic meta-analysis showed limited diagnostic value of PIV (AUROC [area under the receiver operating characteristic curve] = 0.55, 95% CI 0.50-0.59), PNI (AUROC = 0.61, 95% CI 0.57-0.66), and HALP (AUROC = 0.67, 95% CI 0.63-0.71) for post-NAC pCR in BC patients.

CONCLUSION

Our study indicates that PIV, PNI, and HALP before neoadjuvant therapy are independently associated with pCR in patients with BC following NAC. However, their capacity as independent diagnostic indicators remains limited. Additional research is warranted to validate our findings.