Abstract
The prognostic value of the systemic immune-inflammation index (SII) in patients with pancreatic cancer is conflicting according to previous investigations. Therefore, we performed a meta-analysis to explore the association between SII and pancreatic cancer prognosis. Electronic databases were searched for studies exploring the association of SII with prognostic outcomes in pancreatic cancer. The endpoints were overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and clinicopathological parameters. The prognostic value of SII was estimated by hazard ratio (HR) or odds ratio (OR) with a 95% confidence interval (CI). Nine studies containing 11 cohorts with 2,365 subjects in total were included in this meta-analysis. Elevated SII was associated with poor OS (HR=1.50, 95% CI=1.15–1.96, p=0.002), RFS/PFS/DFS (HR=1.52, 95% CI=1.01–2.28, p=0.045), and CSS (HR=2.60, 95% CI=1.65–4.09, p < 0.001) in patients with pancreatic cancer. Additionally, there was no significant association between SII and other parameters in pancreatic cancer such as sex, tumor location, lymph node metastasis, tumor-node-metastasis stage, vascular invasion, and grade. This meta-analysis suggested that elevated SII was a significant prognostic marker for short-term and long-term survival outcomes in patients with pancreatic cancer.
Highlights
Pancreatic cancer is a highly aggressive malignant tumor and the seventh leading cause of cancer-related deaths worldwide [1, 2]
The previous studies published contradictory reports on the prognostic value of systemic immune-inflammation index (SII) in patients with pancreatic cancer [10,11,12,13,14,15]. In this meta-analysis of data gathered from 11 cohorts, with 2,365 subjects, we demonstrated that elevated SII was a significant prognostic factor for overall survival (OS), recurrence-free survival (RFS)/progression-free survival (PFS)/disease-free survival (DFS), and cancerspecific survival (CSS) in pancreatic cancer
The subgroup analysis indicated that elevated SII was predictive of low OS and RFS/PFS/DFS in patients of Asian ethnicity, in stage III-IV/recurrent disease, and with a SII cut-off value ≥ 900
Summary
Pancreatic cancer is a highly aggressive malignant tumor and the seventh leading cause of cancer-related deaths worldwide [1, 2]. In 2018, 458,918 new cases and 432,242 deaths due to pancreatic cancer occurred globally [1]. The prognosis of pancreatic cancer is poor with a 5-year survival rate of less than 5% [4]. Surgical resection is the only curative approach for pancreatic cancer and is feasible in 15% of the cases [4]. Even for patients with operable pancreatic cancer, the 5-year survival rate is only 18%– 24% [5]. One of the major reasons for the poor prognosis is the lack of effective biomarkers [4]; identification of novel prognostic markers is pivotal for better management of patients with pancreatic cancer
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