Predictive value of systemic immune inflammation index (SII) on long-term survival of patients with stage III squamous lung cancer treated with radical radiotherapy

doi:10.11958/20231898

Abstract

Abstract:

Objective To investigate the predictive value of systemic immune inflammation index (SII) scores in long-term survival of patients with stage III squamous lung cancer treated with radical radiotherapy. Methods Clinical data of stage Ⅲ squamous lung cancer patients who underwent radical radiotherapy at the Radiotherapy Department of the Fourth Hospital of Hebei Medical University from January 2010 to December 2018 were retrospectively analyzed. The peripheral hematological indexes one week before radiotherapy were collected and recorded. X-Tile software was applied to determine the best cut-off values for continuous variables. Kaplan-Meier method was used to analyze overall survival (OS) and progression-free survival (PFS). Results A total of 453 patients were included in this study. There were 336 patients in the low SII group (<1 277.3), and other 117 patients were in the high SII group (≥1 277.3). The median OS and median PFS in the high SII group were shorter than those in the low SII group (OS: 20.8 months vs. 31.0 months, Log-rank χ²=18.015, P<0.01; PFS: 13.0 months vs. 21.0 months, Log-rank χ²=15.062, P<0.01).Multivariate Cox regression analysis showed that high SII was associated with OS (HR=1.628, 95%CI: 1.294-2.047, P < 0.001) and PFS (HR=1.559, 95%CI: 1.240-1.961, P < 0.001). Other influencing factors included late TNM stage, poor radiotherapy efficacy and decreased HALP score. Conclusion SII can be used to evaluate the long-term survival of patients with stage III lung squamous cell carcinoma receiving radical radiotherapy, and the increase of SII indicates a poor prognosis.

Key words: lung neoplasms, carcinoma, non-small-cell lung, survival rate, progression-free survival, stage Ⅲ lung squamous cell cancer, radiotherapy, systemic immune-inflammation index

CLC Number:

R734.2

Figures/Tables 6

References 23

[1]	SIEGEL R L, MILLER K D, FUCHS H E, et al. Cancer statistics,2022[J]. CA Cancer J Clin, 2022, 72(1):7-33. doi:10.3322/caac.21708.
[2]	LU T, YANG X, HUANG Y, et al. Trends in the incidence,treatment,and survival of patients with lung cancer in the last four decades[J]. Cancer Manag Res, 2019, 11:943-953. doi:10.2147/CMAR.S187317.
[3]	DOLAN R D, MCSORLEY S T, HORGAN P G, et al. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer:Systematic review and meta-analysis[J]. Crit Rev Oncol Hematol, 2017, 116:134-146. doi:10.1016/j.critrevonc.2017.06.002.
[4]	HAMAKER M E, OOSTERLAAN F, VAN HUIS L H, et al. Nutritional status and interventions for patients with cancer - a systematic review[J]. J Geriatr Oncol, 2021, 12(1):6-21. doi:10.1016/j.jgo.2020.06.020.
[5]	MA S J, YU H, KHAN M, et al. Evaluation of optimal threshold of neutrophil-lymphocyte ratio and its association with survival outcomes among patients with head and neck cancer[J]. JAMA Netw Open, 2022, 5(4):e227567. doi:10.1001/jamanetworkopen.2022.7567.
[6]	XU S S, LI S, XU H X, et al. Haemoglobin,albumin,lymphocyte and platelet predicts postoperative survival in pancreatic cancer[J]. World J Gastroenterol, 2020, 26(8):828-838. doi:10.3748/wjg.v26.i8.828.
[7]	SAKAI A, EBISUMOTO K, IIJIMA H, et al. Chemotherapy following immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma:clinical effectiveness and influence of inflammatory and nutritional factors[J]. Discov Oncol, 2023, 14(1):158. doi:10.1007/s12672-023-00774-4.
[8]	曹志文, 宋东奎, 魏晓松, 等. 术前全身免疫炎症指数对非肌层浸润性膀胱癌患者肿瘤复发的预测价值[J]. 天津医药, 2021, 49(2):159-164.
	CAO Z W, SONG D K, WEI X S, et al. The predictive value of preoperative systemic immune-inflammation index for tumor recurrence in patients with non-muscular invasive bladder cancer[J]. Tianjin Med J, 2021, 49(2):159-164. doi:10.11958/20201927.
[9]	EISENHAUER E A, THERASSE P, BOGAERTS J, et al. New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2):228-247. doi:10.1016/j.ejca.2008.10.026.
[10]	HU B, YANG X R, XU Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma[J]. Clin Cancer Res, 2014, 20(23):6212-6222. doi:10.1158/1078-0432.CCR-14-0442.
[11]	XU Z, CHEN X, YUAN J, et al. Correlations of preoperative systematic immuno-inflammatory index and prognostic nutrition index with a prognosis of patients after radical gastric cancer surgery[J]. Surgery, 2022, 172(1):150-159. doi:10.1016/j.surg.2022.01.006.
[12]	PENG D, ZHANG C J, GONG Y Q, et al. Prognostic significance of HALP (hemoglobin,albumin,lymphocyte and platelet) in patients with bladder cancer after radical cystectomy[J]. Sci Rep, 2018, 8(1):794. doi:10.1038/s41598-018-19146-y.
[13]	GUO Y, SHI D, ZHANG J, et al. The hemoglobin,albumin,lymphocyte,and platelet (HALP)score is a novel significant prognostic factor for patients with metastatic prostate cancer undergoing cytoreductive radical prostatectomy[J]. J Cancer, 2019, 10(1):81-91. doi:10.7150/jca.27210.
[14]	XIE H, RUAN G, WEI L, et al. Comprehensive comparison of the prognostic value of systemic inflammation biomarkers for cancer cachexia:a multicenter prospective study[J]. Inflamm Res, 2022, 71(10/11):1305-1313. doi:10.1007/s00011-022-01626-7.
[15]	PAVAL D R, PATTON R, MCDONALD J, et al. A systematic review examining the relationship between cytokines and cachexia in incurable cancer[J]. J Cachexia Sarcopenia Muscle, 2022, 13(2):824-838. doi:10.1002/jcsm.12912.
[16]	JIANG C, XIU Y, ZHANG S, et al. A novel inflammatory and nutritional prognostic scoring system for nonpathological complete response breast cancer patients undergoing neoadjuvant chemotherapy[J]. Dis Markers, 2022,2022:8044550. doi:10.1155/2022/8044550.
[17]	MANTOVANI A, ALLAVENA P, SICA A, et al. Cancer-related inflammation[J]. Nature, 2008, 454(7203):436-444. doi:10.1038/nature07205.
[18]	HAMILOS M, PETOUSIS S, PARTHENAKIS F. Interaction between platelets and endothelium:from pathophysiology to new therapeutic options[J]. Cardiovasc Diagn Ther, 2018, 8(5):568-580. doi:10.21037/cdt.2018.07.01.
[19]	CHO S Y, HUR M. Expanded impacts of platelet functions:beyond hemostasis and thrombosis[J]. Ann Lab Med, 2019, 39(4):343-344. doi:10.3343/alm.2019.39.4.343.
[20]	CANZLER U, LÜCK H J, NEUSER P, et al. Prognostic role of thrombocytosis in recurrent ovarian cancer:a pooled analysis of the AGO Study Group[J]. Arch Gynecol Obstet, 2020, 301(5):1267-1274. doi:10.1007/s00404-020-05529-y.
[21]	RAO X D, ZHANG H, XU Z S, et al. Poor prognostic role of the pretreatment platelet counts in colorectal cancer:A meta-analysis[J]. Medicine (Baltimore), 2018, 97(23):e10831. doi:10.1097/MD.0000000000010831.
[22]	HUANG H, LIU Q, ZHU L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer[J]. Sci Rep, 2019, 9(1):3284. doi:10.1038/s41598-019-39150-0.
[23]	HUA X, LONG Z Q, ZHANG Y L, et al. Prognostic value of preoperative systemic immune-inflammation index in breast cancer:a propensity score-matching study[J]. Front Oncol, 2020, 10:580. doi:10.3389/fonc.2020.00580.

组别			n			性别（男/女）			年龄（≤60 岁/>60岁）			吸烟史				饮酒史
低SII组			336			313/23			122/214			269（80.1）				73（21.7）
高SII组			117			104/36			48/69			90（76.9）				44（37.6）
χ²						2.159			0.823			0.605				0.103
组别	联合化疗				HALP评分（≤44.1/>44.1）					NLR（≤4.40/>4.40）		处方剂量（≤60 Gy/>60 Gy）
低SII组	265（78.9）				238/98					304/32		223/113
高SII组	79（67.5）				107/10					24/93		86/144
χ²	6.116^＊				20.321^＊＊					212.609^＊＊		2.038
组别			T分期
组别			T1				T2				T3			T4
低SII组			25（7.4）				83（24.7）				102（30.6）			126（37.5）
高SII组			4（3.3）				25（21.4）				32（27.4）			56（47.9）
χ²			5.182
组别				N分期
组别				N1						N2		N3
低SII组				41（12.2）						182（54.2）		113（33.6）
高SII组				11（9.4）						67（57.3）		39（33.3）
χ²				1.036
组别		TNM分期									放疗疗效
组别		ⅢA				ⅢB		ⅢC			CR+PR		SD		PD
低SII组		117（34.8）				134（39.9）		85（25.3）			230（68.5）		104（31.0）		2（0.5）
高SII组		29（24.8）				59（50.4）		29（24.8）			80（68.4）		32（27.4）		5（4.2）
χ²		4.986									7.973^＊

组别			n			性别（男/女）			年龄（≤60 岁/>60岁）			吸烟史				饮酒史
低SII组			336			313/23			122/214			269（80.1）				73（21.7）
高SII组			117			104/36			48/69			90（76.9）				44（37.6）
χ²						2.159			0.823			0.605				0.103
组别	联合化疗				HALP评分（≤44.1/>44.1）					NLR（≤4.40/>4.40）		处方剂量（≤60 Gy/>60 Gy）
低SII组	265（78.9）				238/98					304/32		223/113
高SII组	79（67.5）				107/10					24/93		86/144
χ²	6.116^＊				20.321^＊＊					212.609^＊＊		2.038
组别			T分期
组别			T1				T2				T3			T4
低SII组			25（7.4）				83（24.7）				102（30.6）			126（37.5）
高SII组			4（3.3）				25（21.4）				32（27.4）			56（47.9）
χ²			5.182
组别				N分期
组别				N1						N2		N3
低SII组				41（12.2）						182（54.2）		113（33.6）
高SII组				11（9.4）						67（57.3）		39（33.3）
χ²				1.036
组别		TNM分期									放疗疗效
组别		ⅢA				ⅢB		ⅢC			CR+PR		SD		PD
低SII组		117（34.8）				134（39.9）		85（25.3）			230（68.5）		104（31.0）		2（0.5）
高SII组		29（24.8）				59（50.4）		29（24.8）			80（68.4）		32（27.4）		5（4.2）
χ²		4.986									7.973^＊

组别	n	累积OS率				累积PFS率
组别	n	1年	3年	5年	7年	1年	3年	5年	7年
全组	453	73.7	27.9	18.2	13.1	56.3	21.6	15.3	11.8
低SII组	336	79.8	30.8	20.7	16.1	60.7	24.1	17.8	15.0
高SII组	117	56.4	19.7	10.9	4.8	43.8	14.3	6.9	2.3

组别	n	累积OS率				累积PFS率
组别	n	1年	3年	5年	7年	1年	3年	5年	7年
全组	453	73.7	27.9	18.2	13.1	56.3	21.6	15.3	11.8
低SII组	336	79.8	30.8	20.7	16.1	60.7	24.1	17.8	15.0
高SII组	117	56.4	19.7	10.9	4.8	43.8	14.3	6.9	2.3

因素	β	SE	Wald χ²	P	HR（95%CI）
TNM分期			23.163	<0.001
ⅢB期vs. ⅢA期	0.192	0.124	2.394	0.122	1.212（0.960~1.545）
ⅢC期vs. ⅢA期	0.658	0.139	22.521	<0.001	1.931（1.472~2.534）
联合化疗	0.428	0.120	12.718	<0.001	1.534（1.213~1.941）
放疗疗效			23.197	<0.001
SD vs. CR+PR	0.373	0.113	10.852	0.001	1.452（1.163~1.813）
PD vs. CR+PR	1.504	0.390	14.869	<0.001	4.499（2.095~9.662）
SII	0.478	0.117	17.363	<0.001	1.628（1.294~2.047）
HALP评分	0.549	0.130	17.966	<0.001	1.732（1.343~2.232）