Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease.

Background: There is growing evidence that the systemic immune-inflammation index (SII), a novel prognostic biomarker based on peripheral lymphocyte, neutrophil, and platelet counts, is associated with poor prognosis for several tumors. However, the prognostic value of SII in patients with hepatocellular carcinoma (HCC) who undergo liver transplantation (LT) remains unclear. The aim of this study was to determine the correlation between SII and prognosis in these patients. Methods: This retrospective study involved 150 patients with HCC who underwent LT within the Hangzhou criteria. The optimal cut-off value was determined by receiver-operating characteristic (ROC) curve analysis to stratify the patients into those with a high SII and those with low SII. The Kaplan-Meier method and the Cox proportional hazards model were used to evaluate the prognostic value of SII. Finally, we calculated the area under the ROC curve to compare the prognostic power of SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). Results: Patients were divided into high SII (≥ 226) and low SII (< 226) groups. Five-year overall survival (OS) was lower in the high SII group than in the low SII group (56.1% vs. 82.4%, p = 0.002). SII ≥ 226 × 109/L, maximum tumor size> 5 cm, microvascular invasion, and poor differentiation were independent prognostic factors for OS. However, SII did not predict 5-year recurrence-free survival (high vs. low SII: 64.1% vs. 78.4%, p = 0.073). The area under the ROC curve was greater for SII than for PLR, NLR, and MLR. Conclusions: Preoperative SII may be a powerful prognostic biomarker in patients with HCC who undergo LT within the Hangzhou criteria. SII is superior to PLR, NLR, and MLR for prediction of OS in these patients.

BackgroundIncreasing evidence has highlighted that systemic immune-inflammation index (SII), a recently developed prognostic biomarker that utilizes peripheral platelet, lymphocyte and neutrophil counts, is associated with unfavorable prognosis in various tumors. Nevertheless, the prognostic significance of SII in high-grade gliomas patients undergoing radical resection remains unclear. Therefore, the present study aimed to assess the potential of SII as a prognostic biomarker in this patient population.MethodsA total of 111 adult patients with high-grade gliomas who underwent radical resection were consecutively enrolled in this investigation. The study involved the categorization of patients into high and low SII groups using predetermined cut-off values. Subsequently, forward stepwise logistic regression was employed to identify autonomous predictors for early gliomas recurrence. To mitigate the impact of confounding factors, a propensity score matching (PSM) analysis was performed between high and low SII patients. Finally, the Kaplan-Meier approach was utilized to compare the progression-free survival (PFS) and overall survival (OS) of the two groups.ResultsThe study involved the categorization of patients into two groups based on their SII levels, namely high SII (> 604.8) and low SII (≤ 604.8) groups. Forward stepwise logistic regression revealed that high SII (p < 0.001) and tumor size ≥ 50 mm (p < 0.001) were significantly related to early recurrence of gliomas. Furthermore, the results indicate that PFS and OS were significantly shorter in the high SII group compared to the low SII group, both before and after PSM (p < 0.05).ConclusionPreoperative biomarker SII can serve as a prognostic biomarker for early recurrence and prognosis in patients with high-grade gliomas undergoing radical resection. Furthermore, the combination of tumor size and SII demonstrates a robust predictive capacity for early recurrence and prognosis in this patient population.

BackgroundOptimal medical therapy (OMT) for uncomplicated type B aortic dissection (uTBAD) provides excellent short-term outcomes during follow up; however, its long-term therapeutic effectiveness is unsatisfactory. This study evaluated the predictive value of systemic immune-inflammation index (SII) for adverse events among patients with acute uTBAD undergoing OMT.MethodsWe performed a retrospective analysis of a prospectively maintained database between 2013 and 2020. The primary end point in this study was composite outcomes including aortic intervention, all-cause mortality, retrograde type A aortic dissection (rTAAD) and aortic diameter growth > 5 mm. The patients were divided into high and low SII groups according to the optimal cut-off value of SII as determined using the receiver operating characteristic curve. Cox proportional hazards models were constructed to estimate the hazards ratios and identify the predictors of composite outcomes.ResultsA total of 124 patients with acute uTBAD who underwent OMT were enrolled. One patient died during hospitalisation. At the end of a mean follow-up duration of 51 ± 23 months, 53 (43.1%) patients experienced composite outcomes, 15 patients (12.2%) died, 31 (25.2%) underwent aortic intervention, 21 (17.1%) exhibited diameter growth of > 5 mm, and 2 developed rTAAD. The patients were divided into low SII group (n = 78, 62.9%) and high SII group (n = 46, 37.1%) as per the optimal cut-off SII value of 1449. The incidence of composite outcomes in high SII group was significantly higher than that in low SII (28 [60.9%] vs. 26[33.3%], p < 0.01). Patients with high SII demonstrated significantly higher mortality rate than those with a low SII (11 [23.9%] vs. 5 [6.4%], respectively; p < 0.01). In addition, the high SII group had significantly higher rate of aortic-related reinterventions than the low SII group (16 [34.8%] vs. 15 [19.2%], p = 0.03). Multivariable Cox analyses showed that a high SII score was independently associated with composite outcomes rate (hazard ratio, 2.15; 95% confidence interval, 1.22–3.78; p < 0.01).ConclusionsThe long-term therapeutic effectiveness of OMT alone in patients with acute uTBAD is unsatisfactory. An SII > 1449 at the time of diagnosis is an independent predictor of OMT failure.

BackgroundLocal relapse and distant metastasis are the primary causes of treatment failure and mortality in patients with breast cancer. Triple-negative breast cancer (TNBC) is characterized by limited treatment options, high rates of relapse and metastasis, and poor survival rates. This study aimed to explore the prognostic importance of the systemic immune-inflammation index (SII) among patients with recurrent/metastatic TNBC, focusing on the potential of SII as a novel biomarker for survival prediction.MethodsThis retrospective research involved 62 patients with recurrent/metastatic TNBC who received secondary surgery in Peking Union Medical College Hospital following primary surgery between 2005 and 2018. Clinical data on the preoperative SII, tumor characteristics, and survival outcomes were collected. Receiver operating characteristic (ROC) curve analysis was used for determining the SII optimum cutoff value of 460.45, which was utilized to divide patients into high SII (≥460.45) and low SII (<460.45) groups. Cox regression models, as well as Kaplan-Meier survival curves, were used to evaluate post-recurrence survival (PRS).ResultsIn the high SII group, the patients’ PRS was significantly shorter than that of patients in the low SII group (log-rank P=0.007). Multivariate Cox regression analysis identified a tumor size of >5 cm and a high preoperative SII as independent risk factors for poor prognosis. Notably, 69.4% of the recurrent/metastatic lesions retained the TNBC subtype, whereas 30.6% had molecular subtype changes. Distant metastasis was correlated with worse PRS (log-rank P=0.001); however, changes in tumor molecular subtype did not significantly affect PRS.ConclusionsThe SII is a cost-effective prognostic biomarker for recurrent/metastatic TNBC, reflecting systemic inflammation and immune dysregulation. The dynamic interactions between tumor microenvironment (TME) and systemic inflammation underscore the clinical application of the SII in patient risk stratification and therapeutic decision making. These findings advocate for the integration of SII into routine prognostic assessments and emphasize the importance of repeat biopsy in guiding personalized treatment strategies for patients with recurrent/metastatic TNBC.

We sought to define the association of the systemic immune inflammation index (SII) with prognosis and adjuvant therapy benefit among patients undergoing resection of extrahepatic cholangiocarcinoma (eCCA). The impact of SII on overall (OS) and recurrence-free survival (RFS) following resection of eCCA was assessed and compared with other inflammatory markers and traditional prognostic factors. Propensity score matching (PSM) was used to determine the impact of adjuvant therapy (AT) on OS and RFS relative to low versus high SII. Patients with high versus low SII had worse 5-year OS (15.9% vs. 27.9%) and RFS (12.4% vs. 20.9%) (both p < 0.01). On multivariate analysis, high SII remained associated with worse OS (HR = 1.50, 95% CI 1.20-1.87) and RFS (HR = 1.46, 95% CI 1.18-1.81). Patients with T1/2 disease and a high-SII had worse 5-year OS versus individuals with T3/4 disease and low-SII (5-year OS: T1/2 & low-SII 35.6%, T1/2 & high-SII 16.4%, T3/4 & low-SII 22.1%, T3/4 & high-SII 15.6%, p < 0.01). Similarly, 5-year OS was comparable among individuals with N0 and high-SII versus N1 and low-SII (5-year OS: N0 & high-SII 23.2%, N1 and low-SII 19.8%, p = 0.95). On PSM, AT improved OS and RFS among patients with high SII (5-year OS: 22.5% vs. 12.3%, p < 0.01, 5-year RFS: 19.0% vs. 12.5%; p = 0.01) but not individuals with low SII (5-year OS: 22.9% vs. 26.9%; p = 0.98, 5-year RFS: 18.5% vs. 19.9%; p = 0.94). SII was independently associated with postoperative OS and RFS following curative-intent resection of eCCA. High SII up-staged patients relative T- and N-categories and identified patients with high SII as the most likely to benefit from AT.

e16042 Background: Systemic immune-inflammation index (SII) and programmed death-ligand 1 (PD-L1) are prognostic in various types of malignancies. Recently we have shown a prognostic value of PD-L1 expression on tumor cells and tumor infiltrating lymphocytes (TILs) in testicular germ cell tumors (GCT). This study aimed to evaluate prognostic role of SII in a GCT population of patients expressing PD-L1 on TILs. Methods: SII was calculated using platelet (P), neutrophil (N) and lymphocyte (L) counts measured prior to chemotherapy (SII = P x N/L). SII was calculated in our discovery set of 216 patients with GCT treated at National Cancer Institute and St. Elisabeths' Cancer Institute between 1999 and 2015. A model with median obtained from the discovery data was tested in an independent validation set of 181 patients that were included in a retrospective study evaluating PD-L1 on TILs in GCT. PD-L1 on TILs was detected by immunohistochemistry and scored semiquantitatively by weighted histoscore method. SII was dichotomized into low and high categories based on median value. Results: Low SII ( &lt; 1003) was found in 133 patients (73.5%) as opposed to 48 patients (26.5%) with high SII (≥ 1003). Ten (5.5%) and 171 patients (94.5%) from the validaton set had low (HS &lt; 150) and high (HS ≥ 160) expression of PD-L1 on TILs, respectively. Discovery group of patients with high SII had significantly shorter PFS (HR = 4.48, 95% CI 2.44 – 8.23, p = 0.0000) and OS (HR = 6.10 95% CI 3.11 – 11.95, p = 0.0000) opposite to patients with low SII. PFS from validation set confirmed shorter PFS (HR = 3.03, 95% CI 3.86 – 7.46, p = 0.0062) and OS (HR = 6.49 95% CI 2.10 – 20.03, p = 0.0001) in patients with high versus low SII. A combined prognostic value of PD-L1 TILs and SII uncovered three prognostic groups. The best prognosis was observed in patients with low SII and high PD-L1 on TILs, the worst prognosis was seen in patients with high SII and low PD-L1 on TILs. Patients with SII and PD-L1 on TILs both values high or low had intermediate prognosis. Conclusions: SII was prognostic in our patients with GCT independently of international germ cell cancer collaborative group criteria, suggesting involvement of immune mechanisms in the behavior of GCT.

To investigate the association between the systemic immune-inflammation index (SII) and all-cause mortality in patients with interstitial lung disease (ILD). This retrospective cohort study included 366 patients with ILD. SII was calculated using peripheral blood counts and analyzed as both a continuous and categorical variable based on the optimal cutoff value determined by receiver operating characteristic (ROC) analysis. Kaplan-Meier survival curves were used to compare survival between SII groups. Univariable and multivariable Cox proportional hazards models were applied to evaluate the association between SII and all-cause mortality. Restricted cubic spline (RCS) analysis was performed to assess the dose-response relationship. Subgroup analyses were conducted to examine the robustness of the association. Over a median follow-up of 20.6 months, the primary outcome of all-cause mortality occurred in 91 patients (24.9%). The median SII was significantly higher in deceased patients compared with survivors (1471.14 vs. 1017.21). ROC analysis showed a statistically significant discriminatory ability of SII for mortality prediction (AUC = 0.658, 95% CI 0.594-0.723). Kaplan-Meier analysis demonstrated significantly lower survival in patients with high SII (log-rank p < 0.001). In multivariable Cox models, higher SII remained independently associated with increased all-cause mortality, showing consistent associations across modeling strategies, whether evaluated per standard deviation increase or according to the optimal cutoff value (adjusted HR per standard deviation increase: 1.213, 95% CI 1.048-1.403; adjusted HR for high vs. low SII: 1.717, 95% CI 1.109-2.656; both p < 0.05). RCS analysis revealed a significant linear positive association between SII and mortality risk (P for overall = 0.032; P for nonlinearity = 0.305). Subgroup analyses indicated significant associations between higher SII and all-cause mortality among patients aged ≥60 years, females, and those without anti-synthetase syndrome. Elevated SII is independently and linearly associated with increased all-cause mortality in patients with ILD. These findings suggest that SII may have potential clinical value in the assessment and management of patients with ILD.

Background: Malignant pleural mesothelioma (MPM) represents a fatal disease with high aggressiveness, and limited biomarkers have yet been identified for MPM. The present study aims to explore potential serum prognostic factors of MPM.Materials and methods: A retrospective analysis of 97 pathologically diagnosed MPM was performed. The optimal cutoff value of pretreatment systemic immune–inflammation index (SII) was determined by receiver operating characteristic curve. Kaplan–Meier curves and Cox regression analysis were performed to assess the potential prognostic roles of parameters.Results: A total of 59.8% (n=58) patients are male, with a median age of 56.0 years (range 18–77). The optimal cutoff value of SII was 988.6×109/L. High and low SII were found in 44 (45.4%) and 53 (54.6%) patients, respectively. Median survival time for total 97 cases was 18.5 months. The median overall survival for patients with low and high SII was 47.0 and 13.0 months, respectively. The 1-, 2- and 3-year survival rates for patients with low SII were 85.8%, 57.8% and 52.0% compared to that of 53.9%, 23.6% and 13.8% in patients with high SII. On univariate analysis, Eastern Cooperative Oncology Group performance status (ECOG PS)<2 points, low SII and adjuvant treatment (P<0.05) were found to be closely correlated with a better prognosis of MPM. Only ECOG PS (P=0.036) and SII (P=0.009) held statistical significance on multivariate analysis.Conclusion: Pretreatment SII is easy to access to, and it represents an efficiency and noninvasive biomarker of MPM. High SII represents an unfavorable independent prognostic factor of MPM, and this needs to be validated in further studies.

Background: Mucosal malignant melanoma (MMM) is a rare and aggressive malignancy with a dismal prognosis. While the Systemic Immune-Inflammation Index (SII) has emerged as a prognostic marker in various solid tumors, its specific value in MMM remains undefined. This study investigated the association between pretreatment SII and overall survival (OS) in patients with MMM. Methods: We retrospectively analyzed 106 adults with histologically confirmed MMM treated at six oncology centers in Turkey between 2005 and 2025. The baseline SII was calculated as platelet × neutrophil/lymphocyte counts obtained before definitive treatment. A receiver operating characteristic (ROC) analysis identified an optimal SII cutoff of 776 for overall survival (OS), defining low (<776) and high (≥776) SII groups. Results: Gastrointestinal and head and neck mucosa were the most frequent primary sites, and one-third of patients presented with metastatic disease. The median OS for the entire cohort was 23.3 months. Patients with a high versus low SII had a shorter OS (16.2 vs. 35.2 months; HR 2.71, 95% CI 1.67–4.40; p < 0.001). In multivariable analysis, a high SII (HR 1.88, 95% CI 1.12–3.14; p = 0.016), gastrointestinal primary site (HR 1.99, 95% CI 1.23–3.23; p = 0.005), and metastatic disease at diagnosis (HR 4.01, 95% CI 2.32–6.94; p < 0.001) independently predicted a worse OS. Conclusions: The SII is a novel, independent prognostic biomarker in MMM. Elevated pretreatment SII correlates with aggressive clinicopathologic features and inferior survival. As a readily accessible and cost-effective marker, SII may facilitate improved risk stratification in routine clinical practice for MMM patients.

SII as a predictor of mortality in patients with non-ST-segment elevation myocardial infarction and diabetes mellitus.

We conducted a study to validate the influence of the systemic immune-inflammation index (SII) on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) and to verify whether the implementation of the SII in place of neutrophil and platelet counts within the International Metastatic Renal Cell Carcinoma Consortium (IMDC) model might increase its prognostic accuracy. We retrospectively analyzed consecutive patients with mRCC, who were treated with first-line tyrosine kinase inhibitors from 2008 to 2016 in two major oncology centres in Poland. We stratified patients into low SII (< 730) and high SII (≥ 730) groups according to a recent literature report. We used multivariable Cox proportional hazards regressions (CPHRs) to assess the impact of the SII on OS and concordance, global 'goodness-of-fit', calibration and reclassification measures to quantify a potential prognostic benefit from the modification of the IMDC model. Overall, 502 patients (294 with low and 208 with high SII) were included. Median OS was 36.7 months [95% confidence interval (CI) 30.4-41.5 months] and 17.0 months (95% CI 12.5-19.6 months) in the low and high SII groups, respectively. The SII status was significant in CPHRs with the hazard ratio ranging from 1.38 to 1.68. All prognostic accuracy measures favored the SII-modified-IMDC model over the original IMDC model. Using an external dataset, we showed that high SII was an independent factor for poor OS. The addition of the SII to the IMDC model in place of neutrophil and platelet counts increased the model's prognostic performance.

ObjectiveThis study aimed to investigate the prognostic value of systemic immune inflammation index (SII) concerning long-term outcomes in patients with the three-vessel disease (TVD) after revascularization in a large cohort.MethodsIn total, 3561 TVD patients who had undergone revascularization between 2013 and 2018 were included in the study. Patients were divided into the low SII (<694.3 × 109/L) (n = 2556, 71.8%) and the high SII (≥694.3 × 109/L) group (n = 1005, 28.2%). The C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess whether the addition of SII to a baseline model with traditional risk factors improved the accuracy of cardiac event prediction. The primary outcome was the frequency of major adverse and cerebrovascular events (MACCE). The secondary outcome was the incidence of all-cause death.ResultsAfter 2.4 years of follow-up, the Cox proportional hazard regression model analysis displayed that high SII was independently associated with an increased risk of developing future MACCE (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.23–2.21, p = 0.001) and all-cause death (HR: 2.96; 95% CI: 1.19–7.32, p = 0.019). The addition of SII significantly improved the reclassification beyond the baseline model with traditional risk factors (MACCE: NRI, 0.115; p = 0.0001; all-cause death: NRI, 0.369; p = 0.0001). Reclassification with the addition of SII also demonstrated an IDI of 0.0022 (p = 0.006) in MACCE and 0.0033 (p = 0.014) in all-cause death.ConclusionIn TVD patients after revascularization, increased SII is an independent prognostic factor for long-term outcomes of MACCE and death. Compared to traditional risk factors, SII improved the risk prediction of major cardiovascular events in TVD patients who underwent revascularization.

e16015 Background: The systemic immune-inflammation index (SII) is a prognostic factor in various malignancies that probably reflects a state of immunity. The objective of this retrospective analysis was to explore prognostic value of the SII at baseline and at week 6 during first-line platinum-based chemotherapy in Caucasian population with metastatic urothelial cancer (MUC). Methods: We evaluated 185 consecutive MUC (152 bladder, 72 upper tract) patients (139 men) treated with first-line platinum-based chemotherapy at National Cancer Institute between 2000-2015. Median Karnofsky index was 90% (30–100%), visceral metastases were present in 86 patients. SII was based on platelets (P), neutrophils (N) and lymphocytes (L) counts defined as PxN/L. Progression-free survival (PFS), overall survival (OS) and their 95% CI were estimated by Kaplan-Meier method and compared with logrank test. The study population was dichotomized by median into high SII and low SII groups. Multivariate Cox regression analysis included Karnofski index, status of visceral metastases together with baseline SII and SII at week 6, respectively. Results: At median follow-up 10 months (1-139 months), 170 patients experienced disease progression and 168 of them died.Patients with low SII at baseline had significantly better PFS and OS opposite to those with high SII (HR = 0.62, 95% CI 0.45-0.84 for PFS and HR = 0.52, 95% CI 0.38-0.71 for OS, respectively). Similarly, patients with low SII at 6 weeks had significantly better PFS and OS compared to those with high SII (HR = 0.61, 95% CI 0.45-0.83 for PFS and HR = 0.54, 95% CI 0.40–0.74 for OS, respectively). Multivariate analysis confirmed independent prognostic value of baseline SII and SII at week 6 for PFS and OS. Conclusions: Both, the SII at baseline and at week 6 during treatment with first-line chemotherapy represent independent prognostic factors for Caucasian population with MUC. Based on SII, patients could be stratified into future clinical trials. MUC patients with high SII might be candidates for an experimental first-line treatment.

Background Recently, a novel systemic immune-inflammation index (SII) based on peripheral lymphocytes, neutrophils, and platelets has been reported to be correlated with patient prognosis in several malignancies, including gastric cancer. However, the prognostic value of the SII for gastric cancer patients with a signet-ring cell (SRC) component has not yet been reported. In this study, we aimed to assess the prognostic value of the SII in gastric cancer patients with an SRC component after curative resection. Methods This study was a retrospective analysis of 512 GC patients with an SRC component who underwent curative resection. The prognostic value of the SII was analyzed by the Kaplan-Meier method and Cox proportional hazards regression model. Results In our study cohort, an optimal cut-off value for the SII of 527 was used to stratify patients with gastric cancer (GC) into low (<527) and high SII (≥527) groups. Our study indicated that a high SII (≥527) was significantly correlated with a large tumor size (p < 0.001), infiltration of serosa (p < 0.001), lymph node metastasis (p < 0.001), and advanced TNM stage (p < 0.001). Univariate and multivariate analyses further demonstrated that a low SII was correlated with better clinical outcome and was an independent prognostic predictor in GC patients with an SRC component. Furthermore, the SII retained prognostic value in the subgroup analysis, including subgroup of different TNM stages and pure or mixed signet-ring cell carcinomas (SRCCs). Conclusion The SII is a simple, promising, and practical prognostic biomarker for patients with surgically resected mixed SRCC and pure SRCC. The SII could complement current prognostic tools for better treatment planning and stratification of patients.

Systemic immune-inflammation index (SII) is a novel inflammatory marker based on neutrophils, platelets and lymphocytes counts, which has potential prognostic value among coronary artery disease (CAD) patients as described by some observational studies. We aimed to provide higher-certainty evidence to verify the association of SII with poor outcomes of CAD patients. PubMed, Web of Science, Embase, Ovid and Scopus were searched to find relevant literature exploring the prognostic value of SII among CAD patients. Hazard ratios (HRs) with 95% confidence intervals (CIs) extracted from the literature included were pooled with the fixed-effect or random-effect model. Sensitivity analyses and subgroup analyses were conducted to detect the source of heterogeneity and evaluate the stability of results. A total of nine studies with 15,832 participants were included. The quantitative synthesis including eight studies with 15,657 participants showed that the high SII was related to the major adverse cardiovascular event in CAD patients (HR with 95% CI: 2.36 [1.67, 3.33]). After eliminating heterogeneity and adjusting for publication bias, the above result was still robust (HR with 95% CI: 1.67 [1.32, 2.12]). Additionally, we also demonstrated the prognostic values of SII for all-cause death, cardiovascular death, myocardial infarction and stroke. Higher SII has prognostic values for adverse outcomes in CAD patients.