Keit Emily, Coutu Brendan, Zhen Weining, Zhang Chi, Lin Chi, Bennion Nathan, Ganti Apar Kishor, Ernani Vinicius, Baine Michael
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
Division of Hematology/Oncology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Ann Transl Med. 2021 Feb;9(3):227. doi: 10.21037/atm-20-6710.
The systemic immune-inflammation index (SII) correlates with patient survival in various types of solid malignancies, including non-small cell lung cancer (NSCLC). However, limited information is available on the prognostic implication and disease-specific survival of SII in patients undergoing definitive chemoradiation therapy (CRT) for stage III NSCLC.
We retrospectively reviewed 125 patients who underwent curative intent CRT for stage III NSCLC with sufficient laboratory assessment from 2010-2019. SII was calculated at the time of diagnosis as platelet count × neutrophil count/lymphocyte count. Chi-squared analysis was used to compare categorical variables. A Kaplan-Meier analysis was performed to estimate progression-free survival (PFS), disease specific survival (DSS), and overall survival (OS) rates, with Cox regression used to determine absolute hazards.
At a median follow-up of 19.7 months, 5-year OS, DSS, and PFS rates were 22.6%, 30.9%, and 13.4%, respectively. A low SII (<1,266) at diagnosis was independently associated with an improved OS (HR: 0.399, 95%, CI: 0.247-0.644, P<0.001), DSS (HR: 0.383, 95%, CI: 0.228-0.645, P<0.001), and PFS (HR: 0.616, 95%, CI: 0.407-0.932, P=0.022). We did not detect an association between SII and freedom from recurrence (FFR), freedom from locoregional recurrence (FFLRR), or freedom from distant recurrence (FFDR). NSAID (1,483.4 2,302.9, P=0.038) and statin usage (1,443.9 2,201.7, P=0.046) were associated with a lower SII while COPD exacerbations (2,699.7 1,573.7, P=0.032) and antibiotic prescriptions (2,384.6 1,347.9, P=0.009) were associated with an elevated SII. These factors were not independently associated with improved survival outcomes.
Low SII scores were independently associated with improved OS, DSS, and PFS rates in patients with stage III NSCLC undergoing definitive CRT. NSAIDs and statin usage may be associated with lower SII at diagnosis of NSCLC. This study suggests that SII may be an effective prognostic indicator of patient mortality. Further investigation of the therapeutic potential of these agents in patients with an elevated SII in this setting may be warranted.
全身免疫炎症指数（SII）与包括非小细胞肺癌（NSCLC）在内的多种实体恶性肿瘤患者的生存率相关。然而，关于接受III期NSCLC根治性放化疗（CRT）患者的SII预后意义和疾病特异性生存的信息有限。
我们回顾性分析了2010年至2019年期间接受根治性CRT治疗的125例III期NSCLC患者，这些患者有充分的实验室评估数据。在诊断时计算SII，公式为血小板计数×中性粒细胞计数/淋巴细胞计数。采用卡方分析比较分类变量。进行Kaplan-Meier分析以估计无进展生存期（PFS）、疾病特异性生存期（DSS）和总生存期（OS）率，并用Cox回归确定绝对风险。
中位随访19.7个月，5年OS、DSS和PFS率分别为22.6%、30.9%和13.4%。诊断时低SII（<1266）与改善的OS（HR：0.399，95%CI：0.247 - 0.644，P<0.001）、DSS（HR：0.383，95%CI：0.228 - 0.645，P<0.001）和PFS（HR：0.616，95%CI：0.407 - 0.932，P = 0.022）独立相关。我们未检测到SII与无复发生存（FFR）、无局部区域复发生存（FFLRR）或无远处复发生存（FFDR）之间的关联。非甾体抗炎药（NSAID）使用（1483.4对2302.9，P = 0.038）和他汀类药物使用（1443.9对2201.7，P = 0.046）与较低的SII相关，而慢性阻塞性肺疾病（COPD）加重（2699.7对1573.7，P = 0.032）和抗生素处方（2384.6对1347.9，P = 0.009）与升高的SII相关。这些因素与改善的生存结局无独立关联。
低SII评分与接受根治性CRT的III期NSCLC患者改善的OS、DSS和PFS率独立相关。NSAIDs和他汀类药物使用可能与NSCLC诊断时较低的SII相关。本研究表明SII可能是患者死亡率的有效预后指标。在这种情况下，对这些药物在SII升高患者中的治疗潜力进行进一步研究可能是必要的。
