Journal Article

Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer

Tan, Juan, Zhou, Xi-Lei, Song, Ying-Jian, Song, Ya-Qi, Tong, Yu-Suo

2017

Overview

Background There is increasing evidence that the existence of systemic inflammation response is correlated with poor prognosis in several solid tumors. The aim of this retrospective study was to investigate the association between systemic immune-inflammation index (SII) and therapy response and overall survival in patients with stage III non-small cell lung cancer (NSCLC). The prognostic values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI) were also evaluated. Methods In total, 332 patients with new diagnosis of stage III NSCLC were included in this retrospective analysis. SII was defined as platelet counts × neutrophil counts/lymphocyte counts. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value for SII, NLR, PLR and PNI. Univariate and multivariate survival analysis were performed to identify the factors correlated with overall survival. Results Applying cut-offs of ≥ 660 (SII), ≥ 3.57 (NLR), ≥ 147 (PLR), ≤ 52.95 (PNI), SII ≥ 660 was significantly correlated with worse ECOG PS (< 0.001), higher T stage (< 0.001), advanced clinical stage ( p  = 0.019), and lower response rate ( p  = 0.018). In univariate analysis, SII ≥ 660, NLR ≥ 3.57, PLR ≥ 147, and PNI ≤ 52.95 were significantly associated with worse overall survival ( p all  < 0.001). Patients with SII ≥ 660 had a median overall survival of 10 months, and patients with SII < 660 showed a median overall survival of 30 months. In multivariate analysis only ECOG PS (HR, 1.744; 95% CI 1.158–2.626; p  = 0.008), T stage (HR, 1.332; 95% CI 1.032–1.718; p  = 0.028), N stage (HR, 1.848; 95% CI 1.113–3.068; p  = 0.018), SII (HR, 2.105; 95% CI 1.481–2.741; p  < 0.001) and NLR ≥ 3.57 (HR, 1.934; 95% CI 1.448–2.585; p  < 0.001) were independently correlated with overall survival. Conclusions This study demonstrates that the SII is an independent prognostic indicator of poor outcomes for patients with stage III NSCLC and is superior to other inflammation-based factors in terms of prognostic ability.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Biomedical and Life Sciences / Biomedicine / Blood platelets / Cancer / Cancer microenvironment / Cancer therapies / Carcinoma, Non-Small-Cell Lung - immunology / Carcinoma, Non-Small-Cell Lung - pathology / Carcinoma, Non-Small-Cell Lung - therapy / Care and treatment / Chemoradiation / Chemoradiotherapy / Chemoresistance / Chemotherapy / Colorectal cancer / Esophagus / Evaluation / Female / Health status indicators / Humans / Inflammation / Inflammation - immunology / Inflammation - pathology / Kaplan-Meier Estimate / Lung cancer / Lung cancer, Non-small cell / Lung Neoplasms - immunology / Lung Neoplasms - pathology / Lung Neoplasms - therapy / Lymphocyte Count / Lymphocytes / Male / Medical prognosis / Medical records / Medicine/Public Health / Metastasis / Middle Aged / Multivariate Analysis / Neoplasm Staging / Neutrophils / Neutrophils - pathology / Non-small cell lung cancer, prognostic factor / Non-small cell lung carcinoma / Nutrition Assessment / Patient outcomes / Patients / Platelet Count / Prostate cancer / Radiation therapy / Radiotherapy / Response rates / ROC Curve / Surgery / Systemic immune-inflammation index / Treatment Outcome / Tumors