Prognostic and Clinicopathological Significance of the Systemic Immune-Inflammation Index in Patients With Renal Cell Carcinoma: A Meta-Analysis

Abstract

BackgroundThe systemic immune-inflammation index (SII) is a hematological parameter based on neutrophil, platelet, and lymphocyte counts. Studies that have investigated the prognostic value of SII in patients with renal cell carcinoma (RCC) have reported controversial results. In this study, we systematically investigated the prognostic value of SII in patients with RCC.MethodsWe systematically searched English articles in the PubMed, Embase, Web of Science, and Cochrane Library databases up to October 2021. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were used to obtain pooled results.ResultsThe meta-analysis included 10 studies that enrolled 3,180 patients. A high SII was associated with poor overall survival (HR 1.75, 95% CI 1.33–2.30, p<0.001) in patients with RCC. However, a high SII was not shown to be a significant prognostic factor for progression-free survival/disease-free survival (HR 1.22, 95% CI 0.84–1.76, p=0.293) or poor cancer-specific survival (HR 1.46, 95% CI 0.68–3.12, p=0.332) in patients with RCC. A high SII was correlated with male sex (OR 1.51, 95% CI 1.11–2.04, p=0.008), Fuhrman grade G3–G4 (OR 1.80, 95% CI 1.08–3.00, p=0.024), and poor risk based on the International Metastatic Renal Cell Carcinoma Database Consortium criteria (OR 19.12, 95% CI 9.13–40.06, p<0.001).ConclusionA high SII was independently associated with poor survival outcomes in patients with RCC. Additionally, an elevated SII indicated more aggressive disease. The SII may serve as a useful cost-effective prognostic indicator in patients with RCC.

Role of the Systemic Immune-Inflammation Index in Patients with Metastatic Renal Cell Carcinoma Treated with First-Line Ipilimumab plus Nivolumab

“…Data of a recent meta-analysis is in line with our data: A high SII was associated with poor OS (HR 1.75, 95% CI 1.33–2.30, p < 0 .001) in an all-comer cohort of non-metastatic and metastatic RCC. Contrary to our data, high SII did not prove to be a significant prognostic factor for PFS in this meta-analysis (HR 1.22, 95% CI 0.84–1.76, p = 0.293) [ 22 ], which included TKI-treated patients. A study by Hu et al included in this meta-analysis with non-metastatic RCC patients treated with nephrectomy found that high SII (>529) was an independent predictor of cancer-specific survival (HR 2.17, 95% CI 1.33–3.55, p = 0.002) and OS (HR 2.26, 95% CI 1.44–3.54, p < 0.001) [ 41 ].…”

“…Based on the meta-analysis by Jin et al, the calculated mean cut-off value for SII was 854 with a range of 529–1375 [ 22 ]. ROC analysis showed the optimal cut-off value to be 788 (sensitivity 82.6%, specificity 36.0%) for our collective.…”

“…The cohort was stratified using optimal SII cut-offs, first for initial analysis a cut-off of 854 was used as determined by using meta-analysis [ 22 ], second an optimal SII cut-off value was defined by generating a time-dependent receiver operating characteristic (ROC) curve to determine the Youden index. Based on this result, the total population was divided into two separate SII groups (SII high ≥788 vs. SII low <788).…”

“…Studies included in this meta-analysis comprised non-metastatic RCC patients or patients treated with TKIs in the metastatic setting. Information for dual immune checkpoint inhibition with ipilimumab and nivolumab is missing [ 22 ].…”

The Prognostic and Clinicopathological Significance of Systemic Immune-Inflammation Index in Bladder Cancer

“…They reported that SII can be monitored to guide prognosis and provide useful information about the risk of disease progression in GC. One recent study also indicated that a higher SII was independently related to inferior survival outcomes in renal cell carcinoma patients and that elevated SII suggested more aggressive disease ( 34 ). A baseline SII was also found to be useful in clinical practice to stratify patients with metastatic urothelial carcinoma ( 35 ).…”