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

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

doi:10.1186/s12967-017-1326-1

Abstract

BackgroundThere 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.MethodsIn 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.ResultsApplying 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 (pall < 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.ConclusionsThis 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.

Highlights

There is increasing evidence that the existence of systemic inflammation response is correlated with poor prognosis in several solid tumors
Patients who met the following inclusion criteria were selected: (a) biopsy proven nonsmall cell lung cancer (NSCLC); (b) stage III A or stage III B disease according to the 6th edition of tumor-node-metastasis (TNM) classification; (c) Eastern Cooperative Oncology Group performance status (ECOG PS) (0–2); (d) ≤ 70 years of age; (e) treatment with concurrent CRT or surgery followed by chemoradiotherapy
115 (35%) patients underwent surgical resection followed by chemotherapy or chemoradiotherapy, the remaining patients (n = 217, 65%) received concurrent CRT

Summary

Introduction

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 nonsmall cell lung cancer (NSCLC). 20–25% patients with NSCLC are diagnosed with locally advanced disease (stage III) and have poor survival [3]. For these patients, two standard treatment options are offered: the concurrent chemoradiotherapy (CRT) or induction chemotherapy followed by surgery [4, 5]. NSCLC is poorly chemosensitive to most of the available agents, the reported treatment response rates is only 10–25% [7]

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Conclusion