Prognostic and recurrent significance of SII in patients with pancreatic head cancer undergoing pancreaticoduodenectomy

Abstract

BackgroundTo investigate the clinical significance of preoperative inflammatory status in patients with pancreatic head carcinoma (PHC), we performed a single-center study to assess it.MethodWe studied a total of 164 patients with PHC undergoing PD surgery (with or without allogeneic venous replacement) from January 2018 to April 2022. Systemic immune-inflammation index (SII) was the most important peripheral immune index in predicting the prognosis according to XGBoost analysis. The optimal cutoff value of SII for OS was calculated according to Youden index based on the receiver operating characteristic (ROC) curve and the cohort was divided into Low SII group and High SII group. Demographic, clinical data, laboratory data, follow-up data variables were obtained and compared between the two groups. Kaplan-Meier curves, univariable and multivariable Cox regression models were used to determine the association between preoperative inflammation index, nutritional index and TNM staging system with OS and DFS respectively.ResultsThe median follow-up time was 16 months (IQR 23), and 41.4% of recurrences occurred within 1 year. The cutoff value of SII was 563, with a sensitivity of 70.3%, and a specificity of 60.7%. Peripheral immune status was different between the two groups. Patients in High SII group had higher PAR, NLR than those in Low SII group (P <0.01, <0.01, respectively), and lower PNI (P <0.01). Kaplan–Meier analysis showed significantly poorer OS and DFS (P < 0.001, <0.001, respectively) in patients with high SII. By using the multivariable Cox regression model, high SII (HR, 2.056; 95% CI, 1.082–3.905, P=0.028) was significant predictor of OS. Of these 68 high-risk patients who recurrence within one year, patients with widespread metastasis had lower SII and worse prognosis (P <0.01).ConclusionHigh SII was significantly associated with poor prognosis in patients with PHC. However, in patients who recurrence within one year, SII was lower in patients at TNM stage III. Thus, care needs to be taken to differentiate those high-risk patients.

Prognostic and clinical pathological significance of the systemic immune-inflammation index in urothelial carcinoma: a systematic review and meta-analysis

“…The systemic inflammatory response has been shown to promote cancer progression and contribute to different stages of tumor development, including initiation, invasion, angiogenesis, and metastasis ( 42 ). In recent years, the association between the SII and the prognosis of various cancer types has been extensively investigated, demonstrating its potential as a prognostic indicator, particularly for predicting survival outcomes in patients with malignant tumors ( 16 , 17 , 19 – 25 , 27 ).…”

“…The systemic inflammatory response has been shown to promote cancer progression and contribute to different stages of tumor development, including initiation, invasion, angiogenesis, and metastasis (42). In recent years, the association between the SII and the prognosis of various cancer types has been extensively investigated, demonstrating its potential as a prognostic indicator, particularly for predicting survival outcomes in patients with malignant tumors (16,17,(19)(20)(21)(22)(23)(24)(25)27). SII has been identified as a valuable prognostic indicator for numerous solid tumors, including hepatocellular carcinoma, pancreatic cancer, gallbladder cancer, bile duct cancer, gastric cancer, laryngeal cancer, endometrial cancer, non-small cell lung cancer, and bladder cancer, among others.…”

“…Initial reports have shown that SII can predict the prognosis of patients with hepatocellular carcinoma after radical resection, and it has been identified as a powerful prognostic indicator for poor prognosis in hepatocellular carcinoma patients (15,16). Subsequent studies have confirmed its effectiveness in predicting the prognosis of various cancer patients, including hepatocellular carcinoma (16), pancreatic cancer (17), gallbladder cancer (18), cholangiocarcinoma (19), gastric cancer (20), laryngeal cancer (21), endometrial cancer (22), non-small cell lung cancer (23), and bladder cancer (24). In recent years, the prognostic value of SII in urological system cancers has been investigated and confirmed by many researchers, although the conclusions are not entirely consistent (25)(26)(27)(28).…”

Meaningful nomograms based on systemic immune inflammation index predicted survival in metastatic pancreatic cancer patients receiving chemotherapy

“…SII is calculated by combining lymphocyte count, neutrophil count, and platelet count. SII is a good indicator of the level of immune‐inflammatory response in the body of a tumor patient, according to several studies, 19 , 37 SII is frequently used to help determine prognostic risk in tumor patients. Elevated SII values may indicate increased immune system activity and heightened inflammatory response, which is typically associated with a poor prognosis, including shorter survival and higher rates of disease recurrence.…”

“…By incorporating 164 patients with pancreatic cancer who had resections and a cutoff SII value of 563, Chen et al. 37 found that the high SII group was a separate risk factor for OS, individuals with a worse prognosis and a lower SII had extensive recurrence, only TNM staging was revealed to be an independent predictive predictor for patient recurrence, the researchers speculate that this could be because tumor development and peripheral immune status are tightly related. Widely used in the investigation of various cancers, SII has been linked to poorer overall survival, tumor‐specific survival, and recurrence‐free survival according to Li et al.…”