Using the Systemic Immune-Inflammation Index (SII) as a Mid-Treatment Marker for Survival among Patients with Stage-III Locally Advanced Non-Small Cell Lung Cancer (NSCLC)

Abstract

The Systemic Immune-Inflammation Index (SII) is an important marker of immune function, defined as the product of neutrophil-to-lymphocyte ratio (NLR) and platelet count (P). Higher baseline SII levels have been associated with improved survival in various types of cancers, including lung cancer. Data were obtained from PROCLAIM, a randomized phase III trial comparing two different chemotherapy regimens pemetrexed + cisplatin (PEM) vs. etoposide + cisplatin (ETO), in combination with radiotherapy (RT) for the treatment of stage III non-squamous non-small cell lung cancer (NSCLC). We aimed to determine if SII measured at the mid-treatment window for RT (weeks 3–4) is a significant predictor of survival, and if the effect of PEM vs. ETO differs by quartile (Q) level of SII. Hazard-ratios (HR) for survival were estimated using a proportional hazards model, accounting for the underlying correlated structure of the data. A total of 548 patients were included in our analysis. The median age at baseline was 59 years. Patients were followed for a median of 24 months. Adjusting for age, body mass index, sex, race, and chemotherapy regimen, SII was a significant mid-treatment predictor of both overall (adjusted HR (aHR) = 1.6, p < 0.0001; OS) and progression-free (aHR = 1.3, p = 0.0072; PFS) survival. Among patients with mid-RT SII values above the median (6.8), those receiving PEM (vs. ETO) had superior OS (p = 0.0002) and PFS (p = 0.0002). Our secondary analysis suggests that SII is an informative mid-treatment marker of OS and PFS in locally advanced non-squamous NSCLC.

The Role of the Immune Metabolic Prognostic Index in Patients with Non-Small Cell Lung Cancer (NSCLC) in Radiological Progression during Treatment with Nivolumab

“…As previously shown in the literature [66][67][68], we retrospectively collected white blood cells (WBC), platelets (PLT), absolute neutrophil (ANC), lymphocyte (ALC), and monocyte (AMC) count obtaining their ratio: NLR, derived NLR (dNLR), lymphocyte-to-monocyte ratio (LMR), platelets-to-lymphocyte ratio (PLR), and systemic inflammation index (SII). dNLR was calculated as ANC/(WBC-ANC) and SII as NLRxPLT.…”

The Value of SII in Predicting the Mortality of Patients with Heart Failure

“…It is calculated by P × N / L ratio (SII = P × N / L ratio), where P and N / L are the peripheral platelet count and neutrophil-to-lymphocyte ratio, respectively. At present, studies have shown that there is a certain correlation between the SII and the prognosis of various cancers [ 4 – 7 ].…”

Distinctive Role of the Systemic Inflammatory Profile in Non-Small-Cell Lung Cancer Younger and Elderly Patients Treated with a PD-1 Immune Checkpoint Blockade: A Real-World Retrospective Multi-Institutional Analysis

“…In this regard, several studies have investigated different parameters and nomograms based on inflammation and various hematological variables in order to predict the prognosis of NSCLC patients such as the neutrophil/lymphocyte ratio [44], the thrombocyte/lymphocyte ratio [45], the C-reaction protein-to-albumin ratio [46] and the systemic immune inflammation index [47]. Despite the known effects of age on the inflammation profile [48,49], it is noteworthy to underline the insufficient exploration of this correlation in lung cancer.…”