Prognostic Ability Of Systemic Immune-Inflammation Index In Oral Cavity Patients After Curative Surgery And Post-Operative Radiotherapy.

Abstract

To verify the prognostic ability of preoperative systemic immune-inflammation index (SII) and compare the effect between different markers in oral cavity cancer patients after curative surgery and post-operative chemoradiotherapy (CCRT)/radiotherapy (RT). We reviewed oral cavity cancer patients treated with surgery and RT/CCRT in our hospital from January 2005 to December 2012. Patients having recurrent disease or secondary cancer in 3 years after the index treatment were excluded. We re-classified all staging according to AJCC 8th edition. Patients with multiple risk factors, positive margin or extranodal extension would receive CCRT. The blood sample was obtained within 2 weeks before operation. The sample was excluded if acute infection was noted in medical record. The SII was defined as platelet count multiplied by neutrophil count and divided by lymphocyte count. Chi-square test were used for categorical data. Survival outcome were plotted with Kaplan-Meier method from the first day of RT/CCRT to the date of event of interest (or censored on the last follow-up date). Cox proportional hazard method were used to decide independent predictors of survival. The cut-off values were decided by Youden’s index. Total 995 patients were included, and the median age was 51 years old. Stage 3 and 4 disease accounted for 26.2% and 70.3% patients. 58.8% of these patients have received CCRT. The 5-year and 10-year overall survival (OS) were 57.6% and 44.4%. 5-year local, regional and distant control rate were 77.9%, 85.1% and 80.6% respectively. The cutoff value for SII was 810.6. There were 347(34.9%) patients having high pre-operative SII, and high SII were associate with more advanced T stage patient, buccal cancer patient and tumor depth over 10mm. The multivariate analysis takes all the pathological factors and serum markers, which include neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) and SII into the exam. Higher SII is an independent poor prognostic factor for distant metastasis and overall survival. Median OS for high SII was 4.9 years, in contrast to the median OS for low SII group, 9.4 years. Higher preoperative SII is an independent prognostic factor for oral cavity patient after curative surgery and radiotherapy. This factor may be associate with poor distant control and warrant a more intensive follow up or more aggressive treatment strategy. All these findings still need further external validation or been studied in a prospective study design.Abstract 3963; TableUnivariateMultivariatep-valueAge >651.26(0.97-1.64)N.S.T stage1.48(1.11-1.97)N.S.CCRT0.66(0.56-0.79)N.S.OP-RT interval >6 wks1.34(1.12-1.59)1.25(1.04-1.51)0.020RT time > 8wk1.88(1.50-2.35)1.57(1.22-2.01)<0.001ENE2.07(1.74-2.45)1.92(1.60-2.30)<0.001Lymphatic invasion1.95(1.44-2.65)1.72(1.26-2.36)0.001high LMR0.71(0.60-0.85)0.80(0.65-0.98)0.030high SII1.42(1.20-1.68)1.35(1.11-1.63)0.002 Open table in a new tab