Objective ·To develop a machine learning approach for early identification of metabolic syndromes associated with inflammatory metabolic state changes in breast cancer patients after neoadjuvant therapy, using common laboratory and transthoracic echocardiography indices. Methods ·Female patients with primary invasive breast cancer diagnosed at the Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, between September 2020 and September 2022, were included. General patient information, laboratory test results, and transthoracic echocardiography data were collected. After feature extraction, five machine learning algorithms, including random forest (RF), gradient boosting (GB), support vector machine (SVM), K-nearest neighbor (KNN), and decision tree (DT), were applied to construct a prediction model for the changes of the patients′ metabolic state after neoadjuvant therapy, and the prediction performances of the five models were compared. Results ·A total of 232 cases with valid clinical data were included, comprising 135 cases before neoadjuvant therapy and 97 cases after completing 4 cycles of neoadjuvant therapy. Feature extraction identified five key features: white blood cell count, hemoglobin, high-density lipoprotein (HDL), interleukin-2 receptor, and interleukin-8. In the multi-feature analysis, the area under the receiver operating characferistic curve (AUC) was higher in the combination of white blood cell count, hemoglobin and HDL compared to the combination of interleukin-2 receptor and interleukin-8 (RF: 0.928 vs 0.772, GB: 0.900 vs 0.792, SVM: 0.941 vs 0.764, KNN: 0.907 vs 0.762, DT: 0.799 vs 0.714). The RF, SVM, and GB models showed higher AUC (0.928, 0.941, 0.900) and accuracy (0.914, 0.897, 0.776). The SVM model exhibited superior accuracy in the training data compared to the RF and GB models (P=0.394, 0.122 and 0.097, respectively). Conclusion ·The SVM model can be used to establish a prediction model for identifying breast cancer patients at high risk of developing inflammatory metabolic state-related metabolic syndrome after neoadjuvant therapy by incorporating five common clinical indicators, namely, white blood cell count, hemoglobin, high-density lipoprotein, interleukin-2 receptor, and interleukin-8. SVM modeling may be useful for clinicians to establish individualized screening protocols based on a patient′s inflammatory metabolic state.