Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected esophageal squamous cell carcinoma

Abstract

Background : The systemic immune-inflammation index (SII) has been reported to be associated with patient survival in various kinds of solid tumors. However, just few studies have focused on its prognostic value in patients with surgically resected esophageal squamous cell carcinoma (ESCC). Materials and Methods : This study was a single-institution, retrospective analysis of 468 ESCC patients who underwent curative esophagectomy at the Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2005 and 2008. The receiver operating curve (ROC) was plotted to compare the discrimination ability of the SII and other inflammatory factors for overall survival (OS) and disease-free survival (DFS). Univariate and multivariate analyses were performed based on the Cox proportional hazards regression model. Results : The SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were all associated with OS in ESCC patients. The SII, NLR, and PLR were independent prognostic factors for OS (hazard ratio (HR) = 1.604, 95% confidence interval (CI) 1.247-2.063, P < 0.001; HR = 1.396, 95% CI 1.074-1.815, P = 0.013; HR = 1.370, 95% CI 1.067-1.758, P = 0.013, respectively) and DFS (HR = 1.681, 95% CI 1.307-2.162, P < 0.001; HR = 1.376, 95% CI 1.059-1.788, P = 0.017; HR = 1.398, 95% CI 1.089-1.794, P = 0.009, respectively). The area under the curve (AUC) for SII was bigger than NLR, PLR, and MLR (0.553, 0.540, 0.532, and 0.521, respectively). Conclusion : The SII is a simple and promising prognostic predictor for patients with surgically resected ESCC. The prognostic value of SII is superior to those of the NLR, PLR and MLR. Moreover, the SII retained prognostic significance in stage I-II ESCC subgroup (OS, DFS) and stage III ESCC subgroup (DFS).

<p>Predicting Prognosis and Adverse Events by Hematologic Markers in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Chemoradiotherapy</p>

“…Previous studies have demonstrated that NLR, dNLR, MLR, PLR, SII, AFR, and PNI were significantly associated with poor prognosis. [13][14][15][16][17][18]43 In this study, we included all of these biomarkers, demonstrating that elevated SII and PLR were the only independent prognostic indicators. Furthermore, the AUC of these biomarkers was calculated, suggesting that SII had the maximum AUC value for OS, indicating that SII was the best hematologic biomarker to predict OS in patients with ESCC receiving nCRT.…”

“…In this study, we investigated the association of hematologic indicators, including NLR, dNLR, MLR, PLR, SII, AFR, and PNI, with prognosis and toxicities in patients with ESCC receiving nCRT, demonstrating that pretreatment PLR and SII were the only independent biomarkers to predict prognosis and pretreatment NLR was an independent factor to predict grade ≥3 hematologic toxicity. Previous studies have confirmed that elevated level of pretreatment inflammatory biomarkers were significantly associated with prognosis for esophageal cancer patients who underwent curative esophagectomy or definitive chemoradiotherapy, [13][14][15][16][17][18] but for patients treated with nCRT, the related studies were very limited. Moreover, there has been previously reported that posttreatment NLR was significantly associated with prognosis in malignant tumors treated with chemoradiotherapy, 34 but for ESCC patients, there have no related studies.…”

“…6,7 Previous studies have confirmed that inflammatory biomarkers including preoperative neutrophil to lymphocyte ratio (NLR), preoperative derived neutrophil to lymphocyte ratio (dNLR), preoperative monocyte to lymphocyte ratio (MLR), preoperative platelet to lymphocyte ratio (PLR), preoperative systemic immuneinflammation index (SII), postoperative NLR, and difference in NLR before and after chemoradiotherapy (ΔNLR) are associated with worse prognosis in various malignancies, [8][9][10][11][12] including esophageal cancer. [13][14][15][16][17][18] However, for ESCC undergoing nCRT, data regarding the relationship between pre-and post-treatment levels of inflammatory biomarkers and prognosis or adverse events was very limited. Recently a study demonstrated that ΔNLR was inversely related to pathologic complete response (pCR) and associated with hazard of recurrence in patients with ESCC receiving chemoradiotherapy alone or nCRT.…”

Prognostic value of the systemic immune-inflammation index in patients with breast cancer: a meta-analysis

“…To the best of our knowledge, the present study is the first meta-analysis to evaluate the prognostic and clinicopathological value of the SII in patients with breast cancer. The SII is calculated by using the following formula: neutrophil count × platelet count/lymphocyte count; the SII was developed as a prognostic factor for determining the survival outcomes of patients with various cancers in clinical practice [28][29][30][31][32][33][34]. As the SII is an index of the combination of neutrophil, platelet, and lymphocyte counts, a high SII could be attributed to the changes in the counts of these cells.…”

A Composite Index Predicts Disease Progression in Early Stages of COVID-19: a Propensity Score-matched Cohort Study

“…Elevated NLR represents a risk factor for mortality not only from infectious diseases, but also from malignancies, intracerebral hemorrhage, and dermatomyositis (7)(8)(9). Similarly, increased SII has a prognostic value in a variety of malignancies, including hepatocellular carcinoma, breast cancer, and esophageal squamous cell carcinoma (10)(11)(12). It has been documented that severe and critical COVID-19 cases tend to have higher neutrophil counts and lower lymphocyte counts (1,13).…”