Systemic Immune-Inflammation Index (SII) is Useful to Predict Survival Outcomes in Patients After Liver Transplantation for Hepatocellular Carcinoma within Hangzhou Criteria

Abstract

Background: There is growing evidence that the systemic immune-inflammation index (SII), a novel prognostic biomarker based on peripheral lymphocyte, neutrophil, and platelet counts, is associated with poor prognosis for several tumors. However, the prognostic value of SII in patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT) remains unclear. The aim of this study was to determine the correlation between SII and prognosis in these patients. Methods: This retrospective study involved 150 patients with HCC who underwent LT within the Hangzhou criteria. The optimal cut-off value was determined by receiver-operating characteristic (ROC) curve analysis to stratify the patients into those with a high SII and those with low SII. The Kaplan-Meier method and the Cox proportional hazards model were used to evaluate the prognostic value of SII. Finally, we calculated the area under the ROC curve to compare the prognostic power of SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). Results: Patients were divided into high SII (≥ 226) and low SII (< 226) groups. Five-year overall survival (OS) was lower in the high SII group than in the low SII group (56.1% vs. 82.4%, p = 0.002). SII ≥ 226 × 109/L, maximum tumor size> 5 cm, microvascular invasion, and poor differentiation were independent prognostic factors for OS. However, SII did not predict 5-year recurrence-free survival (high vs. low SII: 64.1% vs. 78.4%, p = 0.073). The area under the ROC curve was greater for SII than for PLR, NLR, and MLR. Conclusions: Preoperative SII may be a powerful prognostic biomarker in patients with HCC who undergo LT within the Hangzhou criteria. SII is superior to PLR, NLR, and MLR for prediction of OS in these patients.

<p>Prognostic Value of Inflammation Biomarkers for Survival of Patients with Neuroblastoma</p>

“…This result is contrary to previous studies focusing on other types of malignancies, while a number of studies found a positive result for NLR, PLR, LMR or SII in the role of predicting the survival for cancer patients. 5,[10][11][12][13][16][17][18][19][20][21][22] In fact, these markers also have their theoretical foundations for predicting the survival of cancer patients. For example, neutrophils could produce various factors that could promote tumor cell proliferation and invasion; lymphocytes could mediate cytotoxic cell death and inhibiting tumor cell proliferation and metastasis; monocytes in the peripheral blood reflect the status of TAM in patients, while TAM derived from monocytes inhibit immune response and promote tumor growth; elevated platelet counts could stimulate tumor angiogenesis and promote tumor metastasis.…”

Preoperative systemic immune-inflammation index predicts prognosis and guides clinical treatment in patients with non-small cell lung cancer

“…These inflammatory indicators are expressed by inflammatory scores, such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and have been reported to be associated with the prognosis of patients with malignant tumors [8,10,11]. Recently, a new inflammatory index, the systemic immune-inflammation index (SII), defined as neutrophil × platelet/lymphocyte, integrates three inflammatory cells and has been shown to be promising [12]. The prognostic value of SII has been confirmed in various cancers, including NSCLC [13], small cell lung cancer [14], esophageal squamous cell carcinoma (SqCC) [15], breast cancer [16] and hepatocellular cancer [17].…”

Prognostic factors of disease-free survival in postoperative patients with hepatocellular carcinoma

“…Many studies had shown that NLR, AFP and brinogen were related to liver cancer patients OS 20,21 . In our study, we used the median of NLR and PLR as their cutoff values,the values were similar to that previously reported 22,23 . To our surprise, hematological indicators such as NLR, PLR and AFP were not prognosis factors of patients DFS.…”