Abstract
Purpose We explored the prognostic influence of the systemic inflammation response index (SIRI) on the survival outcomes of stage IIIB/C non-small-cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy. Methods Present propensity score-matching (PSM) analysis comprised 876 stage IIIB/C NSCLC patients who received 1–3 cycles of platinum-based doublets concurrent with thoracic radiotherapy from 2007 to 2017. The primary and secondary objectives were the relationships between the SIRI values and overall (OS) and progression-free survival, respectively. Propensity scores were calculated for SIRI groups to adjust for confounders and to facilitate well-balanced comparability between the SIRI groups by creating 1 : 1 matched study groups. Results The receiver operating characteristic curve analysis identified an optimal SIRI cutoff at 1.9 for OS (AUC: 78.8%; sensitivity: 73.7%; specificity: 70.7%) and PFS (AUC: 80.5%; sensitivity: 75.8%; specificity: 72.9%) and we grouped the patients into two PSM cohorts: SIRI < 1.9 (N = 304) and SIRI ≥ 1.9 (N = 304), respectively. The SIRI ≥ 1.9 cohort had significantly worse median OS (P < 0.001) and PFS (P < 0.001) than their SIRI < 1.9 companions. The further combination of SIRI with disease stage exhibited that the SIRI-1 (IIIB and SIRI < 1.9) and SIRI-3 (IIIC and SIRI ≥ 1.9) cohorts had the best and worst outcomes, respectively, with SIRI-2 cohort (IIIB and SIRI ≥ 1.9 or IIIC and SIRI < 1.9) being remained in between (P < 0.001 for OS and PFS, separately). In multivariate analysis, the two- and three-laddered stratifications per the 1.9 cutoffs and SIRI groups retained their independent significance, individually. Conclusions The SIRI ≥ 1.9 independently prognosticated significantly worse OS and PFS results and plated the stage IIIB/C patients into three fundamentally distinct prognostic groups.
Highlights
Results of two benchmark phase three randomized clinical trials set the concurrent chemoradiotherapy (C-CRT) as the current standard treatment choice for medically fit stage IIIB/C non-small-cell lung cancer (NSCLC) patients [1, 2]
All patients underwent positron emission tomography computerized tomography (PET-CT) fusion-based RT planning as indicated by our institutional standards for locally advanced NSCLC patients and were treated with 3-dimensional conformal RT (3DCRT) or intensity-modulated RT (IMRT) using megavoltage linear accelerators. e RT techniques, target volume definition, dose specifications, and normal tissue tolerance limits were as previously described by Topkan et al, elsewhere [19]
Discussion e three main discoveries of present propensity score-matching (PSM) analysis comprising 608 stage IIIB/C NSCLC patients were as follows: first, we demonstrated that the pre-C-CRT systemic inflammation response index (SIRI) ≥ 1.9 was an independent predictor of poor prognosis concerning the overall survival (OS) (P < 0.001) and progression-free survival (PFS) (P 0.001)
Summary
Results of two benchmark phase three randomized clinical trials set the concurrent chemoradiotherapy (C-CRT) as the current standard treatment choice for medically fit stage IIIB/C non-small-cell lung cancer (NSCLC) patients [1, 2]. The striking contrasts between the clinical outcomes of patients in comparative disease stages, even with the indistinguishable chemoradiotherapy (C-CRT) regimens, render the prognostic and predictive powers of the TNM framework flawed. Such significant outcome differences might be associated with the strict and sole reliance of the TNM system mainly on the size and local and regional extensions of the primary tumor, with no respect to the tumor- and host-related biological response factors, which may vary extensively among patients [5]. The identification of novel biomarkers may serve usefully in more sophisticated prognostic stratification of such patients when utilized as an adjunct to the TNM staging system
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