High Systemic Immune-inflammation Index Group Research Articles

Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction.

This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) were enrolled in the study. In-hospital and 3-year outcomes were compared between the four groups (Q1-4). The SII was calculated using the following formula: neutrophil*platelet/lymphocyte. The frequency of in-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had an independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. Receiver operating characteristic analysis showed that the best cutoff value of SII to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity. Kaplan-Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6, 96.9, 91.6 and 81.0%, respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had an independent risk for mortality compared to Q1. SII, a novel inflammatory index, was found to be a better predictor for in-hospital and long-term outcomes than traditional risk factors in patients with STEMI undergoing pPCI.

Correlation analysis between preoperative systemic immune inflammation index and prognosis of patients after radical gastric cancer surgery: based on propensity score matching method

BackgroundTo explore the correlation between the preoperative systemic immune inflammation index (SII) and the prognosis of patients with gastric carcinoma (GC).MethodsThe clinical data of 771 GC patients surgically treated in the Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital from June 2010 to June 2015 were retrospectively analyzed, and their preoperative SII was calculated. The optimal cut-off value of preoperative SII was determined using the receiver operating characteristic (ROC) curve, the confounding factors between the two groups were eliminated using the propensity score matching (PSM) method, and the correlation between preoperative SII and clinicopathological characteristics was assessed by chi-square test. Moreover, the overall survival was calculated using Kaplan-Meier method, the survival curve was plotted, and log-rank test was performed for the significance analysis between the curves. Univariate and multivariate analyses were also conducted using the Cox proportional hazards model.ResultsIt was determined by the ROC curve that the optimal cut-off value of preoperative SII was 489.52, based on which 771 GC patients were divided into high SII (H-SII) group and low SII (L-SII) group, followed by PSM in the two groups. The results of Kaplan-Meier analysis showed that before and after PSM, the postoperative 1-, 3-, and 5-year survival rates in L-SII group were superior to those in H-SII group, and the overall survival rate had a statistically significant difference between the two groups (P < 0.05). Before PSM, preoperative SII [hazard ratio (HR) = 2.707, 95% confidence interval (CI) 2.074-3.533, P < 0.001] was an independent risk factor for the prognosis of GC patients. After 1:1 PSM, preoperative SII (HR = 2.669, 95%CI 1.881–3.788, P < 0.001) was still an independent risk factor for the prognosis of GC patients.ConclusionsPreoperative SII is an independent risk factor for the prognosis of GC patients. The increase in preoperative SII in peripheral blood indicates a worse prognosis.

Usefulness of Preoperative High Systemic Immune-Inflammation Index as a Prognostic Biomarker in Patients Who Undergo Radical Cystectomy for Bladder Cancer: Multicenter Analysis.

Evidence of the prognostic value of pretreatment systemic immune-inflammation index (SII) after radical cystectomy (RC) for bladder cancer is limited. This study aims to assess the association between preoperative SII and prognosis after RC for bladder cancer. In this multicenter retrospective study, we calculated preoperative SII as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in 237 patients who underwent RC for bladder cancer between March 2009 and March 2018. Patients were classified into high SII and low SII groups by using the optimal cutoff value (438 × 109/L) based on receiver operating characteristic curve analysis for cancer-specific death. We compared cancer-specific survival (CSS) and overall survival (OS) between the two groups. To evaluate the prognostic impact of preoperative SII, we also performed Cox proportional regression analyses for CSS and OS. Of 237 patients, 127 patients were classified into the high SII group and 110 patients into the low SII group. During the follow-up period, 70 patients died of bladder cancer (30%) and 21 patients died from other causes (9%). Patients with high SII had significantly lower rates of CSS and OS than those with low SII (p < 0.01 and p < 0.01, respectively). Multivariable Cox proportional hazard analysis showed that high SII was independently associated with poor CSS (p = 0.01) and poor OS (p < 0.01). In conclusion, high SII could be an independent significant predictor of poor prognosis after RC in patients with bladder cancer.

Preoperative abdominal fat distribution and systemic immune inflammation were associated with response to intravesical Bacillus Calmette-Guerin immunotherapy in patients with non-muscle invasive bladder cancer

To investigate the predictors of response to intravesical Bacillus Calmette-Guerin (BCG) immunotherapy for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) patients. We retrospectively analyzed the clinicopathological data of 184 intermediate and high risk NMIBC cases receiving transurethral resection of bladder tumor (TURBT) and intravesical BCG immunotherapy from December 2014 to April 2021at our center. All patients were divided into BCG responders and non-responders. Multivariate Logistic regression analysis was performed to identify the independent predictors of response to intravesical BCG immunotherapy. Univariate and multivariate Cox regression analyses were applied to explore the independent prognostic factors of recurrence-free survival (RFS). Receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis were also utilized. The RFS of BCG responders was significantly increased compared with BCG non-responders. Multivariate Cox regression analysis demonstrated that low grade, pTa stage, non-CIS, lower relative visceral fat area (rVFA) and lower systemic immune inflammation index (SII) were independent prognostic factors of increased RFS after intravesical BCG immunotherapy. Multivariate Logistic regression analysis demonstrated that pTa stage, low grade, non-CIS, low rVFA, and low SII were independent predictors of response to intravesical BCG immunotherapy. Kaplan-Meier survival analysis indicated that the RFS of patients in low rVFA group or low SII group was significantly increased in comparison with those in high rVFA group or high SII group. ROC curve analysis showed that the area under ROC (AUC) of including SII and rVFA was significantly increased, indicating that the inclusion of preoperative SII and rVFA could significantly improve the predictive efficiency. Low grade, pTa stage, non-CIS, preoperative lower rVFA and lower SII were vital independent predictors of response to intravesical BCG immunotherapy and were associated with preferable prognosis in NMIBC patients. The inclusion of preoperative SII and rVFA could significantly improve the predictive efficiency.

Survival Prediction by Baseline Systemic Immune-inflammation Index (SII) and its Changes During First-line Platinum-based Treatment in a Caucasian Population of Patients With Metastatic Urothelial Carcinoma (MUC).

Systemic immune-inflammation index (SII) predicts survival of patients with various malignancies. This study explored the prognostic value of SII in metastatic urothelial carcinoma (MUC) subjects. We evaluated 181 consecutive MUC patients treated with first-line platinum-based therapy. Karnofsky performance status <80% and visceral metastasis were present in 18.2% and 46.4% of patients, respectively. SII was based on platelet × neutrophil/lymphocyte counts. Study population was dichotomized by median into high and low SII groups before the initiation of chemotherapy and at week 6. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared with the log-rank test. At median follow-up of 9.6 months, 174 patients experienced disease progression and 173 died. Patients with low SII at baseline and at week 6 had significantly better PFS (HR=0.58; p=0.0002 and HR=0.55; p<0.0001) and OS (HR=0.54; p<0.0001 and HR=0.54; p<0.0001) compared to patients with high SII. Independent prognostic value of SII was confirmed in a multivariate analysis. High SII before chemotherapy that persists at week 6 negatively affects survival. SII at baseline can be used in the stratification of patients within clinical trials and in clinical practice.

The Prognostic Significance of Systemic Immune-Inflammation Index in Patients With Glioblastoma

Inflammation has been demonstrated to play a major role in tumorigenesis and tumor progression. Studies have demonstrated systemic immune-inflammation index (SII) correlates with patient survival in various solid malignancies such as non-small cell lung cancer. However, limited information is available on the prognostic implication of SII index in patients with Glioblastoma undergoing standard Stupp protocol: resection followed by radiotherapy with concurrent and maintenance temozolomide.We retrospectively reviewed 158 patients who underwent standard Stupp protocol for glioblastoma with sufficient laboratory assessment from 2003 - 2018. SII index was determined using a complete metabolic count obtained at the start of treatment and calculated as platelet count × neutrophil count/lymphocyte count. Optimal SII cutoff value was determined by ROC curve analysis. The study cohort was subsequently stratified based on SII cutoff for further comparative analysis using Cox regression. Chi-squared analysis was used to compare categorical variables.The median follow up time of the entire group was 8.4 months. At an optimal SII cutoff of 1635 (AUC 67.7%, P < 0.001), 62 patients (39.2%) were designated in the high SII group and 96 patients (60.8%) were designated in the low SII group. Median OS in high and low SII group was 7.6 months and 15.2 months respectively (P = 0.007). Achieving a gross total resection was associated with low SII (P = 0.020). Age and gender were not associated with SII. In the cox regression analysis, only high SII was independently associated with a worse OS (HR: 2.37, 95% CI: 2.83-1.91, P < 0.001).High SII scores were independently associated with worse OS in patients with Glioblastoma undergoing Stupp Protocol. This study suggests that SII may be an effective pre-treatment prognostic indicator of patient mortality. SII may be a beneficial clinical tool to identify patients with poorer prognosis who may not benefit from aggressive therapy and instead opt for hypofractionation treatment, monomodality treatment, or even best supportive care. Furthermore, the relationship between SII with immunotherapy remains unknown and an investigation of the therapeutic potential in the setting of elevated SII is warranted.M. Hung: None. P. Xu: None. B.G. Coutu: None. C. Zhang: Research Grant; University of Nebraska Medical Center.

Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction

Abstract Background Inflammatory markers are significantly associated with cardiovascular disease and many markers have been used as predictor in patients with STEMI. This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI). Method A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention in a tertiary heart center were enrolled in the study. SII was calculated using the following formula: Platelet × Neutrophil/Lymphocyte ratio. The patients were stratified into four quartiles (Q) according to admission SII level. In-hospital and 3-year outcomes were compared between the four groups (Q1–4) Results In-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events, and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. ROC analysis showed that the best cut-off value of the Systemic Immune-Inflammatory Index to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity (AUC: 0.75; 95% CI: 0.69–0.81; p&amp;lt;0.001). Kaplan Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6%, 96.9%, 91.6% and 81.0% respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had independent risk of death compared to Q1. Conclusion SII, a novel inflammatory index, had a better prediction of in-hospital and long-term outcomes than traditional risk factors in patients with STEMI. Funding Acknowledgement Type of funding sources: None.

Prognostic impact of immune inflammation biomarkers in predicting survival and radiosensitivity in patients with non-small-cell lung cancer treated with chemoradiotherapy.

The purpose of this retrospective study was to investigate the prognostic impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), derived NLR (dNLR) and systemic immune-inflammation index (SII) in predicting outcomes for patients with locally advanced non-small-cell lung cancer (NSCLC). The secondary endpoint was to evaluate the radiosensitivity in terms of response rate. Newly diagnosed locally advanced NSCLC patients were enrolled. Immune inflammation biomarkers were calculated from baseline blood samples. Patients were stratified in two groups based on optimal cut-off values for each biomarker. The associations between biomarkers and overall survival (OS), progression-free survival (PFS), local regional recurrence-free survival (LRRFS), and also response to radiotherapy were analysed. A total of 392 patients were included. Five-year OS, PFS and LRRFS rates were 14.6%, 12.1%, and 13.4% respectively. Optimal cut-off values for NLR, PLR, dNLR and SII were 3.07, 166, 2.02 and 817 respectively. Low NLR (HR 1.73, 95% CI 1.34-2.24, P < 0.001), low PLR (HR 1.37, 95% CI 1.06-1.76, P = 0.013), low dNLR (HR 1.66, 95% CI 1.29-2.13, P < 0.001) and low SII (HR 1.63, 95% CI 1.18-2.04, P < 0.001) were independent prognostic factors for OS. Low NLR, PLR, dNLR and SII were also significant prognostic factors for PFS and LRRFS. Low NLR, low dNLR and low SII groups had better radiosensitivity than compared with high NLR, high dNLR and high SII groups (P = 0.001, P = 0.001 and P = 0.012). NLR, PLR, dNLR and SII were independently associated with improved OS, PFS and LRRFS. Low NLR, dNLR and SII groups had better radiosensitivity. Immune inflammation biomarkers are promising prognostic predictors which can be obtained easily and inexpensively.

The predictive value of the ratio of the product of neutrophils and hemoglobin to lymphocytes in non-muscular invasive bladder cancer patients with postoperative recurrence.

PurposeThe purpose of this study was to explore the predictive value of the ratio of the product of neutrophils and hemoglobin to lymphocytes (NHL) in patients with non‐muscular invasive bladder cancer (NMIBC).Materials and MethodsWe retrospectively collected clinical and pathological data of patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) at our hospital between 2013 and 2018. The ratio of neutrophils to lymphocytes (NLR), the Systemic Immune Inflammation Index (SII), and NHL were obtained based on routine blood settlement within a week before surgery. The receiver operating characteristic curve was used to determine the optimal cutoff value of each index, and different groups were grouped accordingly. Kaplan‐Meier survival curve and Cox regression model were used to study the factors affecting the prognosis of NMIBC patients.ResultsThere was significant difference in recurrence‐free survival (RFS) rate between the high NLR group and the low NLR group, the high SII group and the low SII group, and the high NHL group and the low NHL group. Cox univariate regression analysis showed that tumor number, tumor size, tumor pathological grade, tumor pathological stage, NLR, SII, and NHL were related to postoperative RFS in patients with NMIBC. The tumor number, tumor pathological grade, SII, and NHL were independent predictors of RFS in multivariate analysis.ConclusionsThe preoperative clinical inflammatory indexes NLR, SII, and NHL have certain predictive value for postoperative RFS in NMIBC patients.

Systemic immune-inflammation index as a prognostic marker for distal cholangiocarcinoma.

The systemic immune-inflammation index (SII) is a new marker, defined as the platelet count × neutrophil-to-lymphocyte ratio. This study evaluates the SII as a prognostic marker for the overall survival (OS) of patients who underwent pancreatoduodenectomy (PD) for distal cholangiocarcinoma (DCC). One hundred and forty patients who underwent PD for DCC between September, 2002 and December, 2015 at our hospital were divided into a low SII (SII < 1450) group and a high SII (SII ≥ 1450) group. We compared the clinicopathological characteristics and OS of the two groups retrospectively and used multivariate analyses to identify the prognostic factors for OS. The low and high SII groups comprised 119 and 21 patients, respectively. OS was better in the low SII group than in the high SII group, with median survival times of 81 and 26months, respectively (p < 0.001). Multivariate analyses revealed that portal vein resection (hazard ratio [HR], 9.58; p < 0.001), SII ≥ 1450 (HR, 2.05; p = 0.041), microscopic venous invasion (HR, 2.04; p = 0.005), and pN1 (HR, 1.73; p = 0.034) were independently associated with poor survival. The SII may be useful for predicting the long-term survival of patients with DCC after PD.

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

BackgroundSince inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host’s immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC.MethodsA total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses.ResultsPreoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49–6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07–4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15–4.94), pT4 (HR 4.46, 95% CI 2.44–8.14), and pN+ (HR 4.02, 95% CI 2.10–7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028).ConclusionPreoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy.

Systemic Immune-Inflammation Index Is a Prognostic Predictor in Patients with Intrahepatic Cholangiocarcinoma Undergoing Liver Transplantation.

Background It was reported that systemic immune inflammation index (SII) was related to poor prognosis in a variety of cancers. We aimed to investigate the ability of the prognostic predictors of SII in patients with intrahepatic cholangiocarcinoma (iCCA) undergoing liver transplantation (LT). Methods The 28 iCCA patients who underwent LT at our hospital between 2013 and 2018 were reviewed. Kaplan–Meier survival curves and Cox regression analyses were used to evaluate the prognostic significance of SII. Patients were divided into the high and low SII groups according to the cut-off value. Results The 1-, 3-, and 5-year OS rates were significantly lower in the high SII group (85.7%, 28.6%, and 21.4%, respectively) than in the low SII group (92.9%, 71.4%, and 57.2%, respectively; P = 0.009). The 1-, 3-, and 5-year RFS rates were, respectively, 57.1%, 32.7%, and 21.8% in the high SII group and 85.7%, 61.1%, and 61.1% in the low SII group (P = 0.021). SII ≥ 447.48 × 109/L (HR 0.273, 95% CI 0.082–0.908; P = 0.034) was an independent prognostic factor for OS. Conclusions Our results showed that SII can be used to predict the survival of patients with iCCA who undergo LT.

The value of preoperative systemic immune-inflammation index in predicting vascular invasion of hepatocellular carcinoma: a meta-analysis.

Vascular invasion and systemic immune-inflammation index (SII) are risk factors for the prognosis of patients with hepatocellular carcinoma. At present, the correlation between the two is not clear. This meta-analysis explored the relationship between preoperative SII and vascular invasion in patients with hepatocellular carcinoma. According to the search formula, the Pubmed, Embase, Cochrane, Web of Science, and CNKI databases were searched for the relevant research until March 2020. After the quality evaluation of the included literature, the odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as the effect measure. Stata 15. 0 software was used for statistical analysis. The meta-analysis eventually included seven retrospective cohort studies of 3583 patients with hepatocellular carcinoma. The results showed that the choice of SII cut-off value affects SII's efficiency in predicting the risk of vascular invasion. In the cohort of studies with appropriate SII cut-off value, the high SII preoperative group had a higher risk of vascular invasion (OR=2.62; 95%CI: 2.07-3.32; P=0.000) and microvascular invasion (OR=1.82; 95%CI: 1.01-3.25; P=0.045) than the low SII group. The tumor diameter (OR=2.88; 95%CI: 1.73-4. 80; P=0.000) of the high SII group was larger than that of the low SII group. There was no publication bias in this study (Begg's test, P=0.368). As a routine, cheap, and easily available index, SII can provide a certain reference value for clinicians to evaluate vascular invasion before operation.

Comparison of the prognostic value of immunoinflammation-based biomarkers in patients with gastric cancer.

Background: Systemic immune-inflammation index (SII)—comprising platelet, neutrophil, and lymphocyte count—is an objective and reliable biomarker for predicting the prognosis in cancer patients because it comprehensively reflects the balance between host inflammatory and immune responses. In this study, we clarified the prognostic impact of immunoinflammation-based indices, i. e. SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR), in gastric cancer patients. Results: In multivariate analysis, the American Society of Anesthesiologists physical status (ASA-PS) (hazard ratio [HR]: 3.366, p < 0.001), tumor differentiation (HR: 1.705, p = 0.020), pathological Tumor, Node, Metastasis (pTNM) stage (HR: 2.160, p = 0.008), and carcinoembryonic antigen (CEA) (HR: 1.964, p = 0.003) were independent prognostic factors for OS in all patients. Further, multivariate analysis revealed that age (HR: 2.088, p = 0.040), ASA-PS (HR: 2.339, p = 0.043), tumor differentiation (HR: 1.748, p = 0.044), and pTNM stage (HR: 2.114, p = 0.024) were independent prognostic factors for OS among patients without inflammation; SII was not a prognostic factor for OS. Meanwhile, body mass index (HR: 5.055, p = 0.011), ASA-PS (HR: 3.403, p = 0.007), and SII (HR: 4.208, p = 0.026) were independent prognostic factors for OS among patients with inflammation. Materials and Methods: We performed a retrospective review of 412 patients who underwent curative laparoscopic gastrectomy. The prognostic value of SII was compared between a low SII group (SII<661.9) and high SII group (SII≥661.9). We analyzed the predictive ability of immunoinflammation-based indices for overall survival (OS) based on a C-reactive protein (CRP) level of 0.5. Conclusions: Compared to NLR and PLR, SII is the most significant prognostic biomarker for OS, especially in gastric cancer patients with inflammation.

Inflammation-Based Prognostic Scores in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma After Liver Transplantation.

BackgroundInflammation-based prognostic scores including systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) have prognostic value in various cancers. We investigated the prognostic value of SII, PLR and NLR in patients who underwent liver transplantation (LT) for HBV-related hepatocellular carcinoma (HCC).MethodsWe retrospectively analyzed the records of 189 patients who underwent LT for HBV-related HCC. The receiver operating characteristic (ROC) curve was used to determine the optimal SII, PLR and NLR cut-off value. Overall survival (OS) and recurrence-free survival (RFS) following LT were calculated. The Kaplan–Meier method and the Cox proportional hazards model were used to evaluate the prognostic value of SII, PLR and NLR.ResultsThe 1-, 3-, and 5-year OS rates were significantly lower in the high SII group (74.1%, 34.2%, and 32.3%, respectively) than in the low SII group (78.5%, 66.9%, and 59.9%, respectively; p = 0.000). The 1-, 3-, and 5-year RFS rates were, respectively, 75.9%, 59.7%, and 49.4% in the high SII group and 93.3%, 80.2%, and 73.7% in the low SII group (p = 0.000). Finally, OS curves were plotted by the Kaplan–Meier method and compared using the Log rank test. High PLR and NLR scores were also associated with poor OS (p = 0.000 and p = 0.003) and poor RFS (p = 0.000 and p = 0.000). The multivariate analysis demonstrated that AFP ≥400 ng/mL, high MELD score, largest tumor size ≥5cm, SII ≥449.61, NLR ≥5.29, and PLR ≥98.52 were independent prognostic factors for OS.ConclusionHigh SII, PLR and NLR are significantly poor prognostic factors for overall survival and recurrence-free survival in patients with HBV-related hepatocellular carcinoma after liver transplantation.

Systemic Immune-Inflammation Index Predicts Overall Survival in Patients with Gastric Cancer: a Propensity Score–Matched Analysis

BackgroundThe systemic immune-inflammation index (SII), integrated by peripheral lymphocyte, neutrophil, and platelet counts, is used as an objective biomarker that reflects the balance between host inflammatory and immune response status in cancer patients. Herein, we examined the prognostic significance of SII in gastric cancer patients. MethodsWe retrospectively reviewed data of 415 patients who underwent curative laparoscopic gastrectomy using propensity score–matched (PSM) analysis. The prognostic value of SII was compared between two groups based on SII values: low SII group (SII < 661.9) and high SII group (SII ≥ 661.9). ResultsIn multivariate analysis, the American Society of Anesthesiologists physical status (ASA-PS) (p < 0.001), tumor differentiation (p = 0.019), pathological stage (p = 0.046), carcinoembryonic antigen (CEA) level (p < 0.001), SII (p = 0.006), and operative procedure (p = 0.009) were independent prognostic factors of overall survival (OS) in the overall PSM cohort. The log-rank test demonstrated that patients with a high SII had significantly worse OS than did those with low SII (p = 0.002). In age-stratified subgroups analysis (< 65/≥ 65 years), multivariate analysis revealed that ASA-PS (p < 0.001), tumor differentiation (p = 0.019), CEA level (p = 0.008), SII (p = 0.013), and operative procedure (p = 0.026) were independent prognostic factors of OS in the elderly group. Similarly, elderly patients with a high SII had significantly worse OS than did those with a low SII (p = 0.009). Meanwhile, SII was not an independent prognostic factor of OS, and no significant association was observed between SII and OS in non-elderly patients. ConclusionsSII was an independent prognostic indicator in gastric cancer patients, especially in the elderly population.

Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS)

Introduction Inflammation plays an important role in stroke. Many inflammatory markers in peripheral blood are proved to be associated with stroke severity or prognosis. But few comprehensive models or scales to evaluate the severity of stroke have been reported. Systemic immune-inflammation index (SII) and platelet-albumin-bilirubin (PALBI) grade as new markers of inflammation have shown their positive association with liver cancer. The relation between SII, or PALBI and stroke remains uncertain. Objective To investigate the relationship between SII, PALBI grade and stroke severity. Methods Patients with ischemic stroke with hospital admission <24 h after symptom onset were prospectively included in a stroke registry. Demographic, clinical, and laboratory data were collected immediately after admission in all patients. The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity upon admission. Minor stroke was defined as NIHSS score < =5, moderate-to-severe stroke as NIHSS score >5. SII, calculated as platelet × neutrophil/lymphocyte was divided into four groups according to interquartile range: lowest SII (SII < 353.9 × 109/L), low SII (353.9–532.8 × 109/L), high SII (532.8–783.9 × 109/L), and highest SII (>783.9 × 109/L) group. Results A total of 362 patients with ischemic stroke were included, and between minor and moderate-to-severe stroke significant difference was found in SII (p < 0.0001), NLR (p < 0.0001), and PLR (p = 0.001), respectively. After multivariate regression analyses, SII groups (Odd ratio = 1.351, 95% confidence interval 1.084–1.684, p = 0.007) not PALBI was an independent risk factor for stroke severity. Conclusion We found that SII but not PALBI, which both are markers of inflammation, was independently associated with stroke severity.

Preoperative systemic immune-inflammation index predicts prognosis of patients with non-metastatic renal cell carcinoma: a propensity score-matched analysis

BackgroundA novel systemic immune-inflammation index (SII), based on the neutrophils, lymphocytes and platelet counts, is associated with the prognosis of several cancers. The present study evaluates the prognostic significance of SII in non-metastatic renal cell carcinoma (RCC).MethodThe present study retrospectively reviewed the medical record of patients with non-metastatic RCC who underwent nephrectomy between 2010 and 2013. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cut-off value. In addition, the propensity score matching (PSM) was performed with a matching ratio of 1:1. Univariate and multivariate Cox proportional hazards models were used to identify the prognostic factors. The results were reported by hazard ratio (HR) with 95% confidence interval (95% CI).ResultsA total of 646 patients were included in the final analysis. High SII group (> 529) was significantly associated with older age (P = 0.014), larger tumor (P < 0.001), higher pathological T stage (P < 0.001), higher tumor grade (P < 0.001) and more tumor necrosis (P < 0.001). Multivariate Cox regression analysis demonstrated that the higher preoperative SII was significantly associated with worse overall survival (OS) (HR = 2.26; 95% CI 1.44–3.54; P < 0.001) and cancer-specific survival (CSS) (HR = 2.17; 95% CI 1.33–3.55; P = 0.002). After PSM, elevated preoperative SII was an independent predictor of poor OS (HR = 1.78; 95% CI 1.1–2.87; P = 0.018) and CSS (HR = 1.8; 95% CI 1.07–3.03; P = 0.027).ConclusionIn conclusion, preoperative SII is associated with adverse factors for RCC. Furthermore, higher preoperative SII is an independent predictor of poor OS and CSS in surgically treated patients with non-metastatic RCC. More prospective and large scale studies are warranted to validate our findings.

Preoperative Systemic Immune-Inflammation Index (SII) for Predicting the Survival of Patients with Stage I-III Gastric Cancer with a Signet-Ring Cell (SRC) Component.

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 to predict survival in patients with metastatic urothelial carcinoma treated with second-line vinflunine.

e17019 Background: Based on our previous study, the systemic immune-inflammation index (SII) is a prognostic factor in patients with metastatic urothelial cancer (MUC) treated with platinum-based first-line chemotherapy. The objective of this retrospective analysis was to explore prognostic value of the SII at baseline of second-line chemotherapy with vinflunine in MUC population. Methods: We evaluated 70 consecutive MUC (53 bladder, 21 upper tract) patients (54 men) treated with second-line chemotherapy with vinflunine at four oncological departments since 2010. ECOG performance status (PS) ≤ 1 had 44 patients (pts.), haemoglobin &lt; 10 g/dL was present in 25 pts. and liver involvement in 18 pts. SII was based on platelets (P), neutrophils (N) and lymphocytes (L) counts defined as PxN/L. This study population was dichotomized by median into low SII and high SII groups. Progression-free survival (PFS), overall survival (OS) and their 95% CI were estimated by Kaplan-Meier method and compared with logrank test. Results: At median follow-up of 9.0 months (1-29 months), 68 pts. experienced disease progression and 62 died. Pts. with low SII at baseline had significantly better PFS and OS opposite to those with high SII (HR = 0.61, 95% CI 0.37-1.00, p = 0.0318 for PFS, HR = 0.60, 95% CI 0.36-1.00, p = 0.0312 for OS, respectively). In addition to the prognostic factors by Bellmunt (ECOG PS ≥ 1, liver involvement, haemoglobin &lt; 10 g/dL), we identified peritoneal metastases as a factor associated with significantly worse survival (HR = 0.28, 95% CI 0.11-0.72, p &lt; 0.00001 for PFS, HR = 0.30, 95% CI 0.12-0.75, p &lt; 0.00001 for OS, respectively). Conclusions: The SII at baseline of treatment with second-line vinflunine represents a prognostic factor for pts. with MUC. Based on SII, pts. could be stratified into clinical trials in future. MUC pts. with high SII might be candidates for a different treatment approach. Key Words: Metastatic Urothelial Carcinoma. Systemic Immune-Inflammation Index. Vinflunine. Progression-Free Survival. Overall Survival.