AIMTo investigate the clinical significance of preoperative systemic immune-inflammation index (SII) in patients with colorectal cancer (CRC).METHODSA retrospective analysis of 1383 cases with CRC was performed following radical surgery. SII was calculated with the formula SII = (P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. The clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices such as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with CRC.RESULTSThe optimal cut-off point for SII was defined as 340. The overall survival (OS) and disease-free survival (DFS) were better in patients with low NLR, PLR, and SII (P < 0.05). The SII was an independent predictor of OS and DFS in multivariate analysis. The area under the receiver-operating characteristics (ROC) curve for SII (0.707) was larger than those for NLR (0.602) and PLR (0.566). In contrast to NLR and PLR, SII could effectively discriminate between the TNM subgroups.CONCLUSIONSII is a more powerful tool for predicting survival outcome in patients with CRC. It might assist the identification of high-risk patients among patients with the same TNM stage.

BackgroundDurable efficacy of immune checkpoint blockade (ICB) occurred in a small number of patients with metastatic gastric cancer (mGC) and the determinant biomarker of response to ICB remains unclear.MethodsWe developed an open-source TMEscore R package, to quantify the tumor microenvironment (TME) to aid in addressing this dilemma. Two advanced gastric cancer cohorts (RNAseq, N=45 and NanoString, N=48) and other advanced cancer (N=534) treated with ICB were leveraged to investigate the predictive value of TMEscore. Simultaneously, multi-omics data from The Cancer Genome Atlas of Stomach Adenocarcinoma (TCGA-STAD) and Asian Cancer Research Group (ACRG) were interrogated for underlying mechanisms.ResultsThe predictive capacity of TMEscore was corroborated in patient with mGC cohorts treated with pembrolizumab in a prospective phase 2 clinical trial (NCT02589496, N=45, area under the curve (AUC)=0.891). Notably, TMEscore, which has a larger AUC than programmed death-ligand 1 combined positive score, tumor mutation burden, microsatellite instability, and Epstein-Barr virus, was also validated in the multicenter advanced gastric cancer cohort using NanoString technology (N=48, AUC=0.877). Exploration of the intrinsic mechanisms of TMEscore with TCGA and ACRG multi-omics data identified TME pertinent mechanisms including mutations, metabolism pathways, and epigenetic features.ConclusionsCurrent study highlighted the promising predictive value of TMEscore for patients with mGC. Exploration of TME in multi-omics gastric cancer data may provide the impetus for precision immunotherapy.

AIM:To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index (PNI), neutrophillymphocyte ratio (NLR), and platelet-lymphocyte ratio in gastric cancer. METHODS:We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between 1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Propensity score analysis was performed to adjust variables to control for selection bias. RESULTS:Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring (hazard ratio, 1.668; 95% confidence interval: 1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ- Retrospective Study ORIGINAL ARTICLEⅢ disease (P = 0.019, P < 0.001), T3-T4 tumors (P < 0.001), or lymph node metastasis (P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS (P = 0.022, P = 0.030, P < 0.001, and P = 0.024, respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively. CONCLUSION:PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer. Core tip: This is the first study to compare the prognostic significance of different immuno-nutritional indices including prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR) and plateletlymphocyte ratio (PLR) in gastric cancer. We found that PNI was an independent prognostic factor for overall survival in gastric cancer before and after the propensity score analysis, especially in patients with advanced disease, deep tumors, or lymph node metastasis. We also proposed that a new index-Canton score (a combination of PNI, NLR and PLT) is a superior prognostic factor compared to PNI, NLR, or PLR alone, as it better represents the relative contribution of each of these indices.Sun KY, Xu JB, Chen SL, Yuan YJ, Wu H, Peng JJ, Chen CQ, Guo P, Hao YT, He YL. Novel immunological and nutritionalbased prognostic index for gastric cancer.

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Objective: Synchronic colorectal peritoneal carcinomatosis (SCRPC) was recognized as a predictor of poor prognosis. The aim of this study was to investigate the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) on the survival outcome, which might help determine the treatment management of SCRPC patients. Methods: A total of 103 SCRPC patients following cytoreduction surgery (CRS) and systematic chemotherapy (CT) between 1997 and 2013 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The comparison of the clinicopathological variables and systematic inflammatory biomarkers, including NLR, PLR and SII, was performed by Chi-test and Cox regression analysis. According to the results of multivariate analysis, a prognostic nomogram was generated, and its prediction ability was measured by the concordance index (C-index). The survival curves were generated using the Kaplan-Meier method and survival comparison between groups was conducted via the log-rank test. Results: Univariate analysis revealed that elevated NLR, PLR and SII were significantly correlate with worse survival outcome. Only low SII value was recognized as an independent favorable prognostic factor for overall survival (HR=1.772, 95% CI=1.015-3.095, P=0.044), except for NLR and PLR. The nomogram could perform well in the prediction of overall survival in SCRPC patients (c-index 0.782). Moreover, SII had strong prognostic discriminatory ability to predict survival outcome for the patients receiving completeness of cytoreduction score (CCR) 0/1 or CCR2/3, rather than NLR and PLR. Conclusions: SII was a better inflammation factor to predict the outcomes of SCRPC patients receiving CRS and systematic CT. Low SII value was the most favorable factor benefiting from different level of CRS and it was useful for determining the appropriate treatment strategy for SCRPC patients.

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