Associations of the NPAR index with breast cancer incidence and mortality based on the National Health and Nutrition Examination Survey (NHANES) 2001-2018: a cross-sectional study

作者：Yongcheng Su, Beibei Xu, Miaomiao Ma, Wenqing Zhang, Zhong Ouyang, Tianhui Hu · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000002543 · 被引用次数：20 · 研究领域：Inflammatory Biomarkers in Disease Prognosis、Cancer Risks and Factors、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Breast cancer (BC) remains one of the most prevalent cancers affecting women globally, imposing significant health and economic burdens on both patients and society. This study aims to investigate the relationship between the neutrophil percentage-to-albumin ratio (NPAR) and BC risk and mortality. MATERIALS AND METHODS: Clinical data from 13 540 participants in the NHANES database were analyzed, including 331 individuals with a documented history of BC. Survival analysis and advanced machine learning (ML) techniques were applied to assess the data. RESULTS: Higher NPAR levels were significantly associated with increased BC risk in the unadjusted model, with quartile comparisons revealing an odds ratio (OR) of 1.51 (95% CI: 0.99-2.29, P = 0.057). After adjustment, the OR increased to 1.70 (95% CI: 1.12-2.57, P < 0.05), indicating the robustness of this association. Elevated NPAR levels were also linked to higher all-cause mortality (ACM). Multivariate Cox regression models showed that a one-unit increase in NPAR was associated with adjusted hazard ratios of 1.09 (95% CI: 1.07-1.12) for overall mortality and 1.17 (95% CI: 1.13-1.22) for cardiovascular disease mortality, both with P values <0.001. Restricted cubic splines analysis revealed a linear correlation between NPAR and BC risk ( P for nonlinearity = 0.15), while a nonlinear relationship was observed for ACM ( P for nonlinearity < 0.01). Among nine ML models evaluated, the LightGBM model exhibited the best dia...