Clinical significance of systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) in patients with esophageal cancer: a meta-analysis

Prognostic nutritional index and neutrophil-lymphocyte ratio predict toxicities and prognosis in patients with cervical cancer treated with curative radiochemotherapy

BACKGROUND

This study aimed to investigate the influence of immunonutritional factors on treatment-related toxicities and survival outcomes in patients with cervical cancer undergoing definitive radiochemotherapy.

METHODS

Patients with cervical cancer who received curative radiochemotherapy between 2016 and 2021 were retrospectively investigated. Pretreatment prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were measured. Survival outcomes, acute and late toxicities were evaluated.

RESULTS

Among the 138 patients, those with larger tumor diameters had significantly lower pre-treatment PNI (p = 0.005). Pre-treatment immunonutritional factors were predictive of clinical survival, whereas post-treatment factors did not correlate with prognosis. Patients with low pre-treatment PNI (<49.5) or high NLR (>2.4) had shorter progression-free survival (PFS, HR: 1.86, p = 0.045 for PNI; HR: 3.15, p = 0.002 for NLR) and overall survival (OS, HR: 1.80, p = 0.048 for PNI; HR: 3.83, p = 0.015 for NLR). High pre-treatment NLR was associated with an increased risk of acute diarrhea (p = 0.049) and late severe toxicities (p = 0.046). Combined analysis revealed that pre-treatment good nutritional status and low systemic inflammation were linked to longer PFS (p = 0.007) and OS (p = 0.002), and poor nutritional status and substantial systemic inflammation were associated with higher rates of late severe toxicities (p = 0.036), with higher prognostic value in advanced stage patients.

CONCLUSION

Pretreatment immunonutritional measures serve as quantitative biomarkers for predicting survivals and treatment toxicities in patients with cervical cancer treated with definitive radiochemotherapy.

Investigation of the predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality in patients with endoprosthesis after hip fracture

In this research, we aimed to investigate the predictive value of the systemic immune inflammation index and prognostic nutritional index on mortality among patients with an endoprosthesis after a hip fracture. In this retrospective, cross-sectional study, a total of 915 patient files applied to our hospital between 2020 and 2023 with an endoprosthesis after a hip fracture were subjected to the study. The patients were divided into 2 groups: alive (n = 396; 43.3%) and deceased (n = 519; 56.7%). The eosinophil-to-lymphocyte ratio, hemoglobin-to-red cell distribution width ratio (HRR), mean platelet volume-to-platelet ratio (MPVPR), neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, monocyte-to-eosinophil ratio (MER), neutrophile-to-monocyte ratio, systemic inflammation index (SII), and prognostic nutritional index (PNI) parameters of the patients were evaluated. The mortality rate was higher among male patients, with a statistically significant difference (P < .05). The follow-up duration, albumin, HGB, eosinophil, lymphocyte, eosinophil %, eosinophil-to-lymphocyte ratio, HRR, and PNI means were significantly higher in the living group (P < .05). Age, MPV, MPVPR, neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, MER, and systemic inflammation index were significantly higher in the deceased group (P < .05). The predictive value of gender (B = -0.362; P < .01), age (B = 0.036; P < .01), HRR (B = -1.100; P < .01), MPVPR (B = 8.209; P < .01), MER (B = 0.006; P < .01), and PNI (B = -0.078; P < .01) were statistically significant at the multivariate level. The time of death was significantly predicted by gender (B = 0.10; P < .05), age (B = -0.02; P < 0 = 1), HRR (B = 0.61; P < .01), MPVPR (r = -4.16; P < .01), MER (B = -0.01; P < .05), and PNI (B = 0.03; P < .01). The predictive value of PNI for the 30-day mortality rate was statistically significant (AUC: 0.643; P < .01). For a PNI cutoff value of 34.475, sensitivity was 69.7%, and specificity was 51.1%. The PNI has predictive value both in estimating overall mortality and in predicting the 30-day mortality rates among patients undergoing endoprosthesis after a hip fracture.

High pre-chemoradiotherapy pan-immune-inflammation value levels predict worse outcomes in patients with stage IIIB/C non-small-cell lung cancer

BACKGROUND AND OBJECTIVES

We explored the prognostic usefulness of the pan-immune-inflammation value (PIV) in patients with stage IIIB/C non-small-cell lung cancer (NSCLC) who underwent concurrent chemoradiotherapy (CCRT).

METHODS AND PATIENTS

For all patients, the PIV was calculated using platelet (P), monocyte (M), neutrophil (N), and lymphocyte (L) measures obtained on the first day of CCRT: PIV = P × M × N ÷ L. Using receiver operating characteristic (ROC) curve analysis, we searched for the existence of an ideal cutoff that may partition patients into two groups with unique progression-free- (PFS) and overall survival (OS) results. The primary endpoint of this retrospective cohort research was to determine whether there were any significant relationships between pretreatment PIV measures and post-CCRT OS outcomes.

RESULTS

The present research included a total of 807 stage IIIB/C NSCLC patients. According to ROC curve analysis, the ideal PIV cutoff was 516 [area under the curve (AUC): 67.7%; sensitivity: 66.4%; specificity: 66.1%], which divided the whole cohort into two: low PIV (L-PIV: PIV < 516; N = 436) and high PIV (H-PIV: PIV ≥ 516; N = 371). The comparisons between the PIV groups indicated that either the median PFS (9.2 vs. 13.4 months; P < 0.001) or OS (16.7 vs. 32.7 months; P < 0.001) durations in the H-PIV group were substantially inferior to their L-PIV counterpart. Apart from the H-PIV (P < 0.001), the N3 nodal stage (P = 0.006), IIIC disease stage (P < 0.001), and receiving only one cycle of concurrent chemotherapy (P = 0.005) were also determined to be significant predictors of poor PFS (P < 0.05, for each) and OS (P < 0.05, for each) outcomes in univariate analysis. The multivariate analysis findings revealed that all four variables had independent negative impacts on PFS (P < 0.05, for each) and OS (P < 0.05, for each).

CONCLUSIONS

The findings of this hypothesis-generating retrospective analysis claimed that the novel PIV was an independent and steadfast predictor of PFS and OS in stage IIIB/C NSCLC patients.

Systemic immune-inflammation index predicts prognosis and responsiveness to immunotherapy in cancer patients: a systematic review and meta‑analysis

The systemic immune-inflammation index (SII) is a significant prognostic factor in some cancer types. However, the prognostic role of SII in cancer patients with immunotherapy remains uncertain. We aimed to evaluate the relationship between pretreatment SII and clinical survival outcomes for advanced-stage cancer patients treated with immune checkpoint inhibitors (ICIs). A comprehensive literature search was performed to identify eligible studies concerning the association between pretreatment SII and survival outcomes in advanced cancer patients treated with ICIs. The data were extracted from publications and used to calculate the pooled odds ratio (pOR) for objective response rate (ORR), disease control rate (DCR), and pooled hazard ratio (pHR) for overall survival (OS), progressive-free survival (PFS), along with 95% confidence intervals (95% CIs). Fifteen articles with 2438 participants were included. A higher level of SII indicated a lower ORR (pOR = 0.73, 95% CI 0.56-0.94) and worse DCR (pOR = 0.56, 95% CI 0.35-0.88). High SII was associated with a shorter OS (pHR = 2.33, 95% CI 2.02-2.69) and unfavorable PFS (pHR = 1.85, 95% CI 1.61-2.14). Therefore, high SII level might be a non-invasive and efficacious biomarker of poor tumor response and adverse prognosis of advanced cancer patients with immunotherapy.

Predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality after below-knee amputation

This retrospective cross-sectional study aimed to evaluate the predictive value of SII (Systemic Immune Inflammation Index) and PNI (Prognostic Nutritional Index) with blood ratios on mortality in diabetic foot patients who underwent below-knee amputation. A total of 231 living (n = 71; 30.7%) and exitus (n = 160; 69.3%) patients were evaluated. The mortality group was divided into 3 groups: 30-day mortality (n = 62; 38.8%), 1-year mortality (n = 62; 38.8%), and over-1-year mortality (n = 36; 22.5%). The hemogram, SII, and PNI parameters of the patients were evaluated. Age, some blood count parameters and SII were significantly higher in the exitus group (P < .05). The lymphocyte, monocyte, eosinophil, albumin, and PNI levels were significantly higher in the living group (P < .05). Mortality was significantly predicted by age (B [regression coefficient] = 0.026, P < .05), NLR (neutrophil lymphocyte ratio) (B = -0.065, P < .05), PNI (B = -0.100, P < .01), and SII (B = 0.00000024, P < .01). The predictive values of CAR (C reactive protein albumin ratio), PNI, and SII were 77.3%, 77.0%, and 76.1%, respectively. For CAR of 30.88 cutoff value, the sensitivity and specificity were 79.4% and 64.8%, respectively. For the PNI 22.0143 cutoff value, the sensitivity and specificity were 66.9% and 5.6%, respectively. For the SII 732249.2481 cutoff value, the sensitivity and specificity were 91.9% and 31.0%, respectively. The predictive value of the PNI was significant for mortality time (B = 0.058; P < .01). The predictive value of PNI for 30-day mortality was significant (AUC (area under curve):0.632; P < .01), whereas its predictive value for 1-year mortality and over-1-year mortality after below-knee amputation was statistically insignificant (P > .05). Both the SII and PNI may be evaluated and used to predict mortality after below-knee amputation. The SII had a significant predictive value for 30-day mortality after below-knee amputation.

Prognostic role of preoperative lymphocyte/C-reactive protein associated with upper gastrointestinal cancer: a meta-analysis

Purpose

The lymphocyte/C-reactive protein (LCR) is a novel immunoinflammatory score and prognostic marker, but the relationship between lymphocyte/C-reactive proteins and clinical outcomes in patients with upper gastrointestinal cancers remains controversial. This study aimed to evaluate the relationship between LCR and the prognosis of upper gastrointestinal cancer by systematic evaluation and meta-analysis.

Methods

We systematically searched PubMed, EMBASE, Cochrane, and Web of Science databases to obtain related studies on the relationship between LCR and esophageal cancer (EC), gastric cancer (GC), and esophagogastric junction cancers (EGJ), and used hazard ratio (HR), 95% confidence interval (95%CI) to evaluate the prognostic value of LCR. Outcome measures included overall survival (OS) and disease-free survival (DFS).

Results

Eight retrospective cohort studies with 2838 patients were included. Meta-analysis showed that patients with low LCR cancers had poor overall survival OS and disease-free survival DFS (HR=2.18, 95%CI=1.87-2.55; HR=1.88, 95%CI=1.56-2.26). Subgroup analysis based on cancer type, treatment modality, gender, T stage, TNM stage, country, and LCR threshold showed that lower LCR levels were all associated with worse OS and DFS (P<0.05).

Conclusion

The LCR can be used as a prognostic marker for patients with upper gastrointestinal cancers, and patients with a lower LCR may have a poor prognosis. Due to the limited number of studies included and mostly retrospective studies, the above findings require validation by more high-quality studies.

Systematic Review Registration

https://www.crd.york.ac.uk, identifier CRD42023392433.

Systemic immune-inflammation index: A new marker in differentiation of different thyroid diseases

Inflammation plays an important role in the pathogenesis of many cancer types and is associated with thyroid malignancy. The systemic immune-inflammation index (SII) is a new inflammation marker that can be calculated from routine complete blood count (CBC). This study investigated the association between SII, a marker derived from routine CBC, and different thyroid diseases. The objective was to determine if this simple inflammation marker can distinguish between benign and malignant thyroid diseases. The medical records of all patients who underwent surgical treatment for thyroid disease between January 2018 and January 2022 were systematically evaluated. The routine preoperative CBC parameters' demographic, clinical, and laboratory data were recorded. A total of 241 patients were included in the study, and the patients were grouped as having multinodular goiter (n = 125), lymphocytic thyroiditis (n = 44), and papillary thyroid carcinoma (PTC) (n = 73) according to pathological results. The SII was defined as the ratio of the total count of neutrophils × platelets divided by the lymphocyte count. Subgroup analysis of patients was performed according to the presence of follicular variant or thyroiditis, micro or macro carcinoma, or bilaterality of the tumor. The SII level was significantly higher in the PTC group than in the lymphocytic thyroiditis and multinodular goiter groups (P < .001). When we grouped the patients according to the presence of PTC as benign or malignant, the optimum cutoff point for SII level was found 654.13, with 73.8% sensitivity and 72.3% specificity from ROC analysis. In the subgroup analysis of patients with PTC, the SII level was similar according to the clinicopathological characteristics of the tumor. The differential diagnosis of thyroid diseases is important for patient management. We found that preoperative SII levels were significantly elevated in patients with PTC compared to those with benign thyroid disorders, and this simple marker can be used for the differentiation of benign and malignant thyroid disease.

Real-World Analysis of Clinical Characteristics and Survival Outcomes in Patients With Extensive-Stage SCLC Treated With First-Line Chemoimmunotherapy

Introduction

There are no clinically validated prognostic biomarkers in the management of extensive-stage SCLC (ES-SCLC). We explored the association between clinical characteristics and survival outcomes in patients with ES-SCLC treated with chemoimmunotherapy.

Methods

In this retrospective cohort study, patients with ES-SCLC treated with first-line platinum-etoposide chemotherapy and atezolizumab were identified from medical records. Pretreatment clinical characteristics, biochemical parameters, and tumor and treatment characteristics were collected. Univariate and multivariate Cox regression were used to evaluate treatment effect on progression-free survival (PFS) and overall survival (OS).

Results

We evaluated 75 patients in total. The median PFS and OS were 6.1 months and 9.2 months, respectively. Statistically significant associations were found with lower lactate dehydrogenase and improved OS (hazard ratio [HR] = 1.0, 95% confidence interval [CI]: 1.0-1.01, p = 0.006), whereas higher age (HR = 0.94, 95% CI: 0.90-0.98, p = 0.006) and lower neutrophil-to-lymphocyte ratio (HR = 1.08, 95% CI: 1.02-1.14, p = 0.005) were associated with improved PFS. The number of chemotherapy cycles received were associated with both an improved PFS (HR = 0.57, 95% CI: 0.37-0.89, p = 0.011) and OS (HR = 0.5, 95% CI: 0.30-0.84, p = 0.008).

Conclusions

This study highlights the important effect of chemotherapy on survival. Furthermore, the association between lactate dehydrogenase and neutrophil-to-lymphocyte ratio on survival further suggests that baseline tumor burden and optimizing sarcopenia are important factors for clinicians to consider as we seek to develop personalized treatment for this disease.

A Novel Hematological Inflammation-Nutrition Score (HINS) and Its Related Nomogram Model to Predict Survival Outcome in Advanced Gastric Cancer Patients Receiving First-Line Palliative Chemotherapy

Purpose

This study aims to construct a novel hematological inflammation-nutrition score (HINS) and investigate its prognostic value in patients with advanced gastric cancer (AGC). We investigated the risk stratification performance of HINS and developed a HINS-based nomogram model to predict overall survival by combining traditional predictors.

Patients and Methods

We conducted a retrospective study on 812 AGC patients who received first-line platinum- or fluoropyrimidine-containing chemotherapy at The First Affiliated Hospital of Zhengzhou University Hospital between 2014 and 2019. Patients were randomly divided into a training cohort (N=609) and a validation cohort (N=203). HINS (0-2) was constructed based on a pre-chemotherapy systemic immune-inflammation index (SII) and albumin (ALB). Prognostic factors were screened by univariate and multivariate COX proportional regression models. Significant factors were used to construct a nomogram model. Internal validation was performed by calibration curves, time-dependent receiver operating characteristics (ROC) curves, and decision curve analysis (DCA), evaluating its prediction consistency, discrimination ability, and clinical net benefit.

Results

HINS was constructed based on SII and ALB. HINS showed a better stratification ability than JCOG prognostic index, with significant differences between groups. Multivariate analysis showed that ECOG ≥1 (HR: 1.379; P=0.005), Stage IV (HR: 1.581; P <0.001), diffuse-type histology (HR: 1.586; P <0.001), number of metastases ≥2 (HR: 1.274; P=0.038), without prior gastrectomy (HR: 1.830; P <0.001), ALP ≥ULN (HR: 1.335; P=0.034), HINS (P <0.001) were independent factors of OS. We successfully established a HINS-based nomogram model that showed a strong discriminative ability, accuracy, and clinical utility in training and validation cohorts.

Conclusion

HINS shows a superior risk stratification ability, which might be a potential prognostic biomarker for AGC patients receiving palliative first-line palliative chemotherapy. The HINS-based nomogram model is a convenient and efficient tool for managing prognosis and follow-up treatments.

Prognostic value of pretreatment systemic immune-inflammation index in Chinese esophageal squamous cell carcinoma patients receiving radical radiotherapy: A meta-analysis

BACKGROUND

The association between pretreatment systemic immune-inflammation index (SII) and long-term survival among Chinese esophageal squamous cell carcinoma (ESCC) patients who received radical radiotherapy remains unclear. The aim of this study was to identify the prognostic role of pretreatment SII in Chinese ESCC patients receiving radical radiotherapy based on current evidence.

METHODS

The PubMed, EMBASE, Web of Science and CNKI databases were searched up to March 18, 2023. Primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS), respectively. The hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were combined to assess the predictive role of pretreatment SII for long-term survival of Chinese ESCC patients receiving radiotherapy. All statistical analyses were conducted by STATA 15.0 software.

RESULTS

A total of 8 eligibility studies involving 2101 cases were included in this meta-analysis. The pooled results demonstrated that elevated pretreatment SII was significantly related to worse OS (HR = 1.59, 95% CI: 1.24-2.02, P < .001) and PFS (HR = 1.33, 95% CI: 1.13-1.57, P < .001). Besides, subgroup based on TNM stage showed similar results.

CONCLUSION

Pretreatment SII could serve as a novel prognostic factor in Chinese ESCC patients receiving definitive radiotherapy and patients with an elevated SII may experience poorer survival.

Pre-treatment systemic immune-inflammation index as a non-invasive biomarker for predicting clinical outcomes in patients with renal cell carcinoma: a meta-analysis of 20 studies

INTRODUCTION

To systematically assess the predictive significance of systemic immune-inflammation index (SII) in renal cell carcinoma (RCC).

METHODS

Relevant studies published before November 2022 were retrieved from public databases. Hazard ratio (HR), standardised mean difference (SMD) and relative risk (RR) were calculated to estimate associations of SII with prognosis, treatment responses and clinicopathological features.

RESULTS

Twenty studies involving 6887 patients were eligible. The meta-analysis results revealed a high SII level was associated with worse overall survival (HR: 1.45, p < 0.001), progression-free survival (HR: 1.63, p = 0.001), cancer-specific survival (HR: 1.86, p < 0.001), lower overall response rate (RR: 0.62, p = 0.003), disease control rate (RR: 0.69, p = 0.002), larger tumour size (SMD: 0.39, p = 0.001), poorer IMDC risk (RR: 7.09, p < 0.001), higher Fuhrman grade (RR: 1.54, p = 0.004), tumour stage (RR: 1.67, p = 0.045), the presence of distant metastasis (brain: RR, 2.04, p = 0.001; bone: RR, 1.33, p = 0.024) and tumour necrosis (RR: 1.57, p = 0.031). Subgroup analysis showed SII predicted OS and PFS for non-Asian, but CSS for both Asian and non-Asian populations.

CONCLUSION

Pre-treatment SII may be a promising predictor of clinical outcomes for RCC patients.

Prognostic value of preoperative C-reactive protein to albumin ratio in patients with thymic epithelial tumors: a retrospective study

Background

The C-reactive protein to albumin ratio (CAR) is associated with poor prognosis in various cancers. However, its value in thymic epithelial tumors remains to be elucidated, we aimed to evaluate the prognostic significance of preoperative CAR in patients with surgically resected thymic epithelial tumors (TETs).

Methods

We retrospectively collected data from 125 patients with TETs who underwent thymoma resection at our center. The best cutoff values ​​for the continuous variable, CAR, were obtained using X-tile software. Univariate and multivariate Cox regression analyses were used to evaluate CAR as an independent predictor of overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier analysis and log-rank tests were used to present risk stratification of patients based on CAR and the Glasgow-prognostic-score (GPS). The prognostic effect of CAR was assessed using a receiver operating characteristic curve.

Results

Patients were categorized into high (≥ 0.17) and low (< 0.17) CAR groups according to the optimal cutoff value of 0.17. Univariate and multivariate analyses showed that CAR was an independent predictor of prognosis. World health organization stage, CAR level, GPS score, and drinking history were important independent prognostic factors for OS (p < 0.05). T stage, CAR level, and drinking history were important independent prognostic factors for RFS (p < 0.05). The area under the curve value of CAR to predict prognosis was 0.734 for OS and 0.680 for RFS.

Conclusions

Elevated preoperative CAR was independently associated with poor OS and RFS after thymectomy. Therefore, CAR may be a valuable biomarker for the postoperative prognosis of TETs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10234-x.

Prognostic significance of the systemic immune inflammation index in patients with metastatic and unresectable pancreatic cancer

Purpose

Systemic inflammatory markers may be predictors of the survival rate of patients with pancreatic cancer (PC). The aim of this work was to investigate the prognostic value of markers, mainly the systemic immune inflammation index (SII), in patients with metastatic and unresectable PC and to explore the relationship between markers and liver metastasis.

Methods

Records of patients with metastatic and unresectable PC at the Affiliated Hospital of Qingdao University from January 2000 to December 2019 and who were followed until December 2020 were retrospectively analyzed. Clinical data and laboratory indexes were collected, and cut-off values for inflammatory markers were determined using median values. The Cox proportional hazard model was used to analyze the prognostic value of the markers through univariate and multivariate survival analysis.

Results

All 253 patients met the inclusion criteria, and 102 (42.0%) patients had liver metastasis. The patients were divided into a high SII group and a low SII group, and the cut-off value was 533. In the multivariate analysis, high SII (HR = 2.151; p &lt; 0.001), chemotherapy (HR = 0.546; p &lt; 0.001), lymph node metastasis (HR = 4.053; p &lt; 0.001), and distant metastasis (HR = 1.725; p = 0.001) were independent risk markers of overall survival (OS). The level of markers, mainly SII, PLR and NLR, were higher in patients with liver metastasis.

Conclusions

A high level of SII is an independent risk factor for short overall survival of patients with metastatic and unresectable PC. Patients with a high level of the inflammatory markers SII, PLR, and NLR, may be more prone to early liver metastasis.

The prognostic value of systemic immune-inflammation index in surgical esophageal cancer patients: An updated meta-analysis

Purpose

To identify the prognostic role of systemic immune-inflammation index (SII) in esophageal cancer patients receiving operation.

Methods

The PubMed, EMBASE, Web of Science, Cochrane Library, WanFang and CNKI electronic databases were searched up to February 17, 2022 for relevant studies. The hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to assess the association between SII and prognosis in surgical esophageal cancer patients. The primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS) and cancer-specific survival (CSS). All statistical analyses were conducted by STATA 15.0 software.

Results

A total of nine retrospective studies involving 3,565 participates were included. The pooled results indicated that high SII was significantly related with poor OS (HR = 1.58, 95% CI: 1.23–2.02, P < 0.001). However, subgroup analysis based on pathological type demonstrated that high SII was an independent predictor for poor OS only in esophageal squamous cell carcinoma (ESCC) patients (HR = 1.72, 95% CI: 1.34–2.21, P < 0.001). Besides, SII was also significantly associated with poor PFS (HR = 1.94, 95% CI: 1.61–2.35, P < 0.001) and CSS (HR = 1.44, 95% CI: 1.04–1.99, P = 0.027) in ESCC patients.

Conclusion

The SII could serve as an independent prognostic factor in surgical ESCC patients and higher SII was related with worse survival. However, more prospective high-quality studies are still needed to verify above findings.

Prognostic Value of Preoperative Nutritional Assessment and Neutrophil-to-Lymphocyte Ratio in Patients With Thymic Epithelial Tumors

Introduction

Systemic nutrition and immune inflammation are the key factors in cancer development and metastasis. This study aimed to compare and assess four nutritional status and immune indicators: prognostic nutritional index (PNI), nutritional risk index (NRI), neutrophil-to-lymphocyte ratio (NLR), and the systemic immune-inflammatory index (SII) as prognostic indicators for patients with thymic epithelial tumors.

Materials

We retrospectively reviewed 154 patients who underwent thymic epithelial tumor resection at our hospital between 2004 and 2015. The optimal cutoff value for each nutritional and immune index was obtained using the X-tile software. Kaplan-Meier curves and Cox proportional hazards models were used for survival analysis.

Results

Univariate analysis showed that PNI, NRI, NLR, SII, albumin (ALB), the albumin/globulin ratio (A/G), WHO stage, T stage, and drinking history were associated with the overall survival (OS) of patients (P < 0.05). The NRI, NLR, A/G, ALB, T stage, and WHO stage were significant independent prognostic factors of OS in multivariate analysis (P < 0.05). Finally, we constructed a coNRI-NLR model to predict OS and recurrence-free survival (RFS).

Conclusions

This study suggests that the preoperative NRI, NLR, and coNRI-NLR model may be important prognostic factors for patients with thymic epithelial tumors who undergo surgical resection.

Prognostic Significance of the Systemic Immune-Inflammation Index in Patients With Cholangiocarcinoma: A Meta-Analysis

Background

The systemic immune-inflammation index (SII) is a significant prognostic factor for neoplastic diseases. However, the prognostic value of SII in patients with cholangiocarcinoma (CCA) remains unclear. This meta-analysis aimed to investigate the prognostic value of preoperative SII in patients with CCA.

Method

We systematically searched for relevant studies in PubMed, Scopus, EMBASE, Web of Science, PROSPERO, and Cochrane Library databases up to March 22, 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate the association between SII and survival outcomes, including overall survival (OS) and recurrence-free survival.

Results

Five studies with 1402 patients were included in this meta-analysis to determine the prognostic value of preoperative SII. The results showed that a higher SII was associated with poor OS in patients with CCA who underwent invasive surgery (HR=1.916; 95% CI, 1.566–2.343; Z=6.329; P<0.001). The results were reliable in the subgroup analysis according to country, age, sample size, SII cutoff values, and treatment methods.

Conclusions

A high preoperative SII appears to be an effective and practical method for monitoring survival in patients with CCA.

Systematic Review Registration

International Platform of Registered Systematic. Review and Meta-Analysis Protocols (INPLASY), identifier INPLASY202240015.

Prognostic significance of systemic immune-inflammation index and platelet-albumin-bilirubin grade in patients with pancreatic cancer undergoing radical surgery

BACKGROUND

Systemic inflammatory markers are associated with patient survival in pancreatic cancer (PC). The aim of this study was to investigate the prognostic significance of the systemic immune-inflammation index (SII) in PC patients who underwent radical surgery. Platelet-albumin-bilirubin (PALBI) grade is a composite evaluation index based on liver function. Patients with pancreatic head cancer are prone to obstructive jaundice, which leads to abnormal liver function. Based on this, we also explored the prognostic value of PALBI grade in PC patients.

METHODS

Patients with pathologically confirmed PC who had undergone radical surgery (with negative surgical margin) for the first time at the Affiliated Hospital of Qingdao University from January 2013 to December 2019 and followed up by December 2020 were retrospectively analyzed. Peripheral blood cell count is easily affected by infection or hematological diseases, which affects the results, so it is excluded. Clinical data and laboratory examination indexes were collected. The SII and PALBI grade were calculated. The cutoff values were determined using the Youden index. The Cox proportional hazards regression model was used to analyze the prognostic value of the SII and PALBI grade through univariate and multivariate survival analysis.

RESULTS

A total of 214 patients [median age, 60.29 years; 128 (59.8%) men] met the inclusion criteria. There were 140 patients (65.4%) with pancreatic head cancer according to the tumor location. They were divided into high and low SII or PALBI groups by cutoff values of 705 and -5.6, respectively. According to the multivariate analysis, SII (P<0.001) was an independent factor negatively associated with overall survival (OS) and disease-free survival (DFS). In patients with pancreatic head cancer, PALBI grade was associated with shorter OS (P=0.031). The combination of high SII and high PALBI grade had stronger predictive value for poor prognosis (log-rank test, P<0.001), which the OS was 11.3 months less than the combination of low two groups.

CONCLUSIONS

SII was a promising prognostic biomarker in PC. And PALBI grade also showed predictive value for patients with pancreatic head cancer. Therefore, it can help predict the treatment outcomes in these patients.

Prognostic and Clinical Significance of Aspartate Aminotransferase-to-Lymphocyte Ratio Index in Individuals with Liver Cancer: A Meta-Analysis

Objective

This study was aimed at exploring the prognostic and clinicopathological roles of aspartate aminotransferase-to-lymphocyte ratio index (ALRI) in patients with hepatocellular carcinoma via a meta-analysis.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were comprehensively searched from inception to November 20, 2021. Pooled hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to evaluate the relationship between ALRI and overall survival (OS) as well as progression-free survival (PFS) in patients with hepatocellular carcinoma. Odds ratio (OR) and the corresponding 95% CI were also used to investigate correlations between clinical factors and ALRI in patients with hepatocellular carcinoma.

Results

A total of 3914 patients with hepatocellular carcinoma from eleven retrospective cohorts were included in this meta-analysis. The combined results revealed that patients with hepatocellular carcinoma with elevated ALRI tended to have unfavorable OS (HR 1.53 [95% CI 1.25–1.82]; P < 0.001). Pooled HRs revealed that high ALRI was an independent risk factor for inferior PFS in patients with hepatocellular carcinoma (HR 1.36 [95% CI 1.10–1.63]; P < 0.001). In addition, high ALRI was strongly associated with male sex (OR 1.32 [95% CI 1.02–1.70]; P = 0.035), presence of cirrhosis (OR 1.68 [95% CI 1.01–2.81]; P = 0.046), larger tumor size (OR 2.25 [95% CI 1.31–3.88]; P < 0.001), presence of portal vein tumor thrombus (OR 2.50 [95% CI 1.52–4.11]; P < 0.001), and distant metastasis (OR 1.72 [95% CI 1.05-2.82]; P = 0.031).

Conclusion

Elevated ALRI in patients with hepatocellular carcinoma predicted inferior survival outcomes and was strongly associated with some important features of hepatocellular carcinoma.

The Systemic Immune-Inflammation Index is an Independent Predictor of Survival in Breast Cancer Patients

Purpose

The current investigation examines the potential clinical value and prognostic significance of a systemic immune-inflammation index (SII) in patients with breast cancer.

Patients and Methods

A total of 477 individuals underwent neoadjuvant chemotherapy, and 308 individuals did not at our center between January 1998 and December 2016 were selected. An optimized SII threshold was generated using a receiver operating characteristic curve (ROC). The relationship between various factors and breast cancer in predicting disease-free survival (DFS) and overall survival (OS) were analyzed.

Results

The SII < 560 group (Low SII group) and SII ≥ 560 group (High SII group) are divided according to the threshold value. SII was an independent predictor for breast cancer DFS and OS based on univariate and multivariate analyses. Low SII patients had higher mean DFS and OS in contrast to those in the high SII groups (46.65 vs 27.37 months and 69.92 vs 49.53 months). Those in the low SII cohort who also had early or advanced breast cancer, different molecular subtypes, and with or without lymph vessel invasion all had higher mean survival time of DFS and OS in contrast to those with raised SII values (P<0.05). The mean DFS and OS durations also varied based on different Miller and Payne grades (MPG) (P <0.005), and different response groups (P<0.05).

Conclusion

SII can be used as an easily accessible and minimally invasive potential prognostic factor in individuals with breast cancer and may also guide clinicians in treating and prognosticating patients with breast cancer.

Development and Validation of a New Integrative Score Based on Various Systemic Inflammatory and Nutritional Indicators in Predicting Prognosis in Patients With Resectable Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study

Background

Recent studies revealed that various inflammatory and nutritional indexes were associated with prognosis in esophageal cancer (EC). However, these studies only evaluated one or two indexes, and the prognostic value of these indexes individually or in combination is unclear. This study aimed to construct an integrative score based on various inflammatory and nutritional indexes for prognosis in resectable esophageal squamous cell carcinoma (ESCC).

Methods

A total of 421 consecutive patients were randomly divided into either a training or validation cohort at a ratio of 7:3 for retrospective analysis. Using logic regression analyses, independent risk factors from peripheral blood indexes were screened to construct an integrative score. The associations regarding the integrative score, clinical characteristics, cancer-specific survival (CSS), and overall survival (OS) were analyzed.

Results

Out of 20 indexes, hemoglobin (HB), C-reactive protein to albumin ratio (CAR), and platelet to lymphocyte ratio (PLR) were independent risk factors based on logical regression analyses. Then, an integrative score with the optimal cut-off value of .67 was established according to the Combination Of HB, CAR, and PLR (COHCP). The area under the curve (AUC) indicated higher predictive ability of COHCP on prognosis than other indicators. Multivariate analyses revealed that COHCP serves as an independent prognostic score. Patients with COHCP low group (≤.67) had better 5-year CSS (57.3% vs 13.5%, P < .001) and OS (51.1% vs 12.3%, P < .001) than those with high group, respectively. Finally, the nomogram based on COHCP was established and validated regarding CSS and OS, which can accurately and effectively predict individual survival in resected ESCC.

Conclusion

The COHCP was a novel, simple, and useful predictor in resectable ESCC. The COHCP-based nomogram may accurately and effectively predict survival.

C-Reactive Protein and C-Reactive Protein-Based Scores to Predict Survival in Esophageal and Junctional Adenocarcinoma: Systematic Review and Meta-Analysis

BACKGROUND

Esophageal adenocarcinoma (EAC) has a poor prognosis; predictive markers of prognosis would facilitate advances in personalized therapy. C-reactive protein (CRP) and CRP-based scores are increasingly recommended across oncology; however, their role and value in EAC is unclear. This systematic review and meta-analysis examined CRP cut-point and scores and how they may best be applied in predicting survival in EAC.

METHODS

A systematic literature search was conducted in EMBASE, Medline, Web of Science, Cochrane, Scopus and CINAHL databases, from inception to 1st October 2020. Studies reporting data from adults with EAC including adenocarcinoma of the gastro-esophageal junction (AEG), pre-treatment CRP or CRP-based score and Hazard Ratio (HR) for survival were included. QUIPS tool assessed risk of bias. Meta-analysis was undertaken.

RESULTS

A total of 819 records were screened. Eight papers were included, with data for 1475 people. CRP cut-points ranged from 2.8 to 10 mg/L. The Glasgow Prognostic Score (GPS) and modified GPS were the most commonly reported scores. On meta-analysis, elevated preoperative GPS/mGPS was significantly associated with worse overall survival (hazards ratio [HR] 1.81, 95% confidence interval [CI] 1.25-2.62, p = 0.002); results were similar in subgroup analyses of multimodal treatment, M0 disease, and R0 resection.

CONCLUSIONS

This is the first review to evaluate comprehensively the evidence for CRP and CRP-based scores in EAC. Meta-analysis demonstrated that elevated preoperative GPS or mGPS was significantly associated with reduced overall survival in EAC, including AEG. There is insufficient evidence to support use of CRP alone. Future studies should examine GPS/mGPS in EAC prospectively, alone and combined with other prognostic markers.

Systemic immune-inflammation index as a promising predictor of mortality in patients with acute coronary syndrome: a real-world study

Objective

Prognostic indicators in acute coronary syndrome (ACS) would aid in decision-making and identifying high-risk patients. The systemic immune-inflammation index (SII) has good prognostic value in many diseases; however, its use has not been reported for ACS. We aimed to determine the associations between the SII and outcomes in patients with ACS, with adjustment for confounders.

Methods

In this retrospective cohort study, we used the MIMIC-III (Multiparameter Intelligent Monitoring in Intensive Care) database and the eICU Collaborative Research Database. The primary outcome was 30-day mortality. Cox regression analysis was performed to determine the relationship between the SII and patient outcomes, and we conducted subgroup analysis and smooth curve fitting.

Results

We identified 4699 patients with ACS: 1741 women and 2949 men, mean age 82.8±29.7 years, and mean SII 72.58±12.9. For 30-day all-cause mortality, the unadjusted hazard ratio (HR) (95% confidence interval [CI]) of SII <69.4 and SII >88.8 were 1.25 (1.04, 1.50) and 1.38 (1.15, 1.65), respectively. With SII >88.8, this association remained significant after adjustment for numerous potential confounders: HR 1.27 (1.06, 1.52). A similar relationship was observed for 90-day and 1-year all-cause mortality.

Conclusions

SII is a promising prognostic indicator for unselected patients with ACS. This finding needs to be confirmed in prospective studies.

Predictive value of postoperative C-reactive protein-to-albumin ratio in anastomotic leakage after esophagectomy

Introduction

Among the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious. Therefore, the purpose of this study was to explore the ability of various inflammatory and nutritional markers to predict postoperative AL in patients after esophagectomy.

Methods

A total of 273 patients were retrospectively evaluated and enrolled into this study. Perioperative, surgery-related, tumor-related and laboratory tests data were extracted and analyzed. The discriminatory ability and optimal cut-off value was evaluated according to the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were performed to access the potential risk factors for AL.

Results

The overall incidence of AL was 12.5% (34/273). C-reactive protein-to-albumin ratio (CRP/ALB ratio) [AUC 0.943 (95% confidence interval (CI) = 0.911–0.976, p <  0.001)] and operation time [AUC 0.747 (95% CI = 0.679–0.815, p <  0.001)] had the greatest discrimination on AL prediction. Multivariate analysis demonstrated that CRP/ALB ratio and operation time were two independent risk factors for AL, and CRP/ALB ratio (OR = 102.909, p <  0.001) had an advantage over operation time (OR = 9.363, p = 0.020; Table 3).

Conclusion

Operation time and postoperative CRP/ALB ratio were two independent predictive indexes for AL. Postoperative CRP/ALB ratio greater than 3.00 indicated a high risk of AL. For patients with abnormal postoperative CRP/ALB ratio, early non-operative treatment or surgical intervention are needed to reduce the serious sequelae of AL.

Prognostic value of systemic immune-inflammatory index in survival outcome in gastric cancer: a meta-analysis

Background

In recent years, many studies have reported that the systemic immune-inflammatory index (SII) can be used to predict the prognosis of cancer patients; however, this finding remains controversial in gastric cancer (GC). Therefore, the purpose of this study was to systematically and comprehensively probe the prognostic role of SII in GC.

Methods

Relevant publications were extracted from PubMed, EMBASE, Cochrane Library databases, and WANFANG DATA (Chinese database). The included studies had patients with pathologically confirmed GC and long-term follow-up data. The patient's outcome was death, recurrence, or status at the end of follow-up. The studies included randomized controlled tests, case-control studies, or cohort studies using a multivariate proportional hazard model adjusted for survival outcomes. Cochran's Q test and Higgins' I-squared statistic were performed to assess heterogeneity. Publication bias was assessed by visual inspection of a Begg's funnel plot.

Results

A total of 6,925 patients in 11 studies were included. The pooled hazard ratio (HR) indicated that a higher SII value was significantly associated with worse overall survival (OS) [HR: 1.53, 95% confidence interval (CI): 1.27-1.83] and worse disease-free survival (DFS) (HR: 1.57, 95% CI: 1.24-1.97) in GC patients. In the subgroup analysis, the HR was 1.72 (95% CI: 1.51-1.95) and 1.27 (95% CI: 0.96-1.67) in the group of patients aged <59 and ≥59 years, respectively.

Conclusions

The pooled HR indicates that a higher SII in younger patients with GC predicts a poor prognosis. In elderly patients with GC, the prognostic role of SII needs further research.

Predictive value of C-reactive protein to albumin ratio as a biomarker for initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients: a prospective cohort study

BACKGROUND

Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). This study aimed to prospectively investigated the value of C-reactive protein-to-albumin (CAR) in predicting both initial and repeated IVIG resistance in patients with KD, and to test the hypothesis that CAR was more valuable or accurate than either C-reactive protein (CRP) or albumin (ALB) alone in IVIG resistance prediction.

METHOD

A prospective cohort study involving 550 patients with KD was conducted. The clinical and laboratory data were compared between IVIG-response group and IVIG-resistance group. Multivariate logistic regression analysis was performed to identify the independent risk factors of initial/repeated IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of CAR, CRP and ALB in predicting both initial and repeated IVIG resistance.

RESULTS

CAR was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD. The best cut-off value of CAR for initial and repeated IVIG resistance prediction was 2.07 and 3.34, with a corresponding sensitivity of 0.610 and 0.548, a specificity of 0.552 and 0.813, respectively. The value of CAR was not better than either CRP or ALB alone for both initial and repeated IVIG resistance prediction.

CONCLUSION

A higher CAR was an independent risk factor for both initial and repeated IVIG resistance. However, similar with that of CRP or ALB, the predictive value of CAR was not good enough for both initial and repeated IVIG resistance prediction in KD.

Prognostic Value of Pretreatment Systemic Immune-Inflammation Index in Gastric Cancer: A Meta-Analysis

Background

Previous studies have investigated the role of systemic immune-inflammation index (SII) as a prognostic factor for gastric cancer (GC) patients, although with inconsistent results. Thus, the aim of this study was to identify the prognostic value of SII in GC through meta-analysis.

Methods

We systematically searched the PubMed, Embase, and Web of Science databases for relevant studies investigating the prognostic role of SII in GC up to December 2019. The hazard ratios (HRs) and 95% confidence intervals (CIs) related to overall survival (OS) and disease-free survival (DFS) were combined. Odds ratios (ORs) and 95% CIs were pooled to assess the correlation between SII and clinicopathological features of GC.

Results

A total of eight studies, comprising 4,236 patients, were included in this meta-analysis. Pooled analysis indicated that a high pretreatment SII predicted poor OS (HR=1.40, 95% CI=1.08–1.81, p=0.010) but not poor DFS (HR=1.30, 95% CI=0.92–1.83, p=0.140) in GC. In addition, an elevated SII correlated with an advanced tumor–node–metastasis stage (OR=2.34, 95% CI=1.40–3.92, p=0.001), T3–T4 stage (OR=2.25, 95% CI=1.34–3.77, p=0.002), positive lymph node metastasis (OR=1.79, 95% CI=1.12–2.87, p=0.016), and tumor size ≥ 5 cm (OR=2.28, 95% CI=1.62–3.22, p<0.001) in patients with GC.

Conclusions

A high pretreatment SII significantly associated with poorer survival outcomes as well as several clinical characteristics in GC. We suggest that SII could be monitored to guide prognostication and provide reliable information on the risk of disease progression in GC.

Clinical Significance of C-Reactive Protein to Albumin Ratio in Patients with Hepatocellular Carcinoma: A Meta-Analysis

Aim

To evaluate the prognostic significance of C-reactive protein to albumin ratio (CAR) for clinical outcomes in hepatocellular carcinoma (HCC) patients. Material and Methods. Eligible studies were searched by PubMed, MedLine, the Cochrane Library, from January 1, 2000, to June 30, 2019, investigating the prognostic value of CAR in patients with HCC. Primary endpoint was OS. Hazard ratio (HR) with 95% confidence interval (CI) was used to determine the effect size.

Results

7 records including 2208 patients published since 2014 were enrolled into our meta-analysis. Clinicopathological characteristics were also correlated with the level of CAR. The pooled HR for the OS rate between low and high CAR groups was 2.13 (95% CI 1.70~2.68, P < 0.00001) using a random model, but sensitivity analysis showed that the pooled HR for the OS rates did not change substantially after removal of any included study. As for patients receiving surgery, the pooled HR for the OS rate between low and high CAR groups was 2.04 (95% CI 1.59~2.61, P < 0.00001). Subgroup analysis showed that CAR could be a prognostic biomarker for HCC patients regardless of regions (China, HR = 1.75, 95% CI 1.51~2.02; Japan, HR = 3.36, 95% CI 2.07~5.45; Korea, HR = 2.26, 95% CI 1.47~4.47; respectively), the cut-off value (<0.1, HR = 2.84, 95% CI 1.90~4.24; >0.1, HR = 1.99, 95% CI 1.52~2.61; respectively), and sample size (<200, HR = 2.85, 95% CI 2.01~4.03; >200, HR = 1.75, 95% CI 1.52~2.02; respectively).

Conclusion

With the current data, we clearly concluded that CAR was closely correlated with prognosis of patients with HCC. Multicenter, prospective randomized trials are warranted to confirm the conclusion.

Prognostic prediction of systemic immune-inflammation index for patients with gynecological and breast cancers: a meta-analysis

BACKGROUND

Systemic immune-inflammation index (SII) has been suggested to be effective to reflect the inflammatory status and thus may be an underlying biomarker for prognosis prediction. This hypothesis has been demonstrated in meta-analyses on several cancer types. However, there was no study to confirm the prognostic roles of SII for gynecological and breast cancers, which was the goal of our study.

METHODS

PubMed, EMBASE, and Cochrane Library databases were searched to collect the articles exploring the associations of SII with prognostic outcomes [overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), lymph node metastasis (LNM), and lymphovascular invasion (LVI)] in gynecological and breast cancers. The prognostic value of SII was estimated by hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI).

RESULTS

Nine articles involving 2724 patients in 11 datasets were included. Meta-analysis showed that a high SII index was significantly associated with poor OS (HR = 2.12, 95% CI, 1.61-2.79, P < 0.001), DFS/PFS (HR = 2.28, 95% CI 1.52-3.41, P < 0.001) and an increased risk for LNM (RR = 1.34, 95% CI 1.20-1.50, P < 0.001) in patients with gynecological and breast cancers. Subgroup analysis confirmed the prognostic role of SII for OS was applicable to all cancer types, but the association with DFS/PFS and LNM was only significant for ovarian cancer and breast cancer, especially triple-negative breast cancer. No significant association was detected between SII and LVI.

CONCLUSION

High SII may be a promising indicator for the prediction of poor prognosis in patients with gynecological and breast cancers, especially ovarian cancer and triple-negative breast cancer.

Prognostic value of lymphocyte-to-monocyte ratio and systemic immune-inflammation index in non-small-cell lung cancer patients with brain metastases

Aim: We aimed to evaluate the prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) in patients with brain metastases from non-small-cell lung cancer (NSCLC). Materials & methods: We conducted Kaplan-Meier analysis and multivariable Cox analysis to evaluate the prognostic values of NLR, PLR, LMR and SII. Results: Kaplan-Meier analysis showed that the patients in low LMR, high NLR, PLR and SII groups were associated with shorter overall survival. Multivariable Cox analysis revealed LMR and SII were independent prognostic factors for overall survival (p = 0.002 and p = 0.004, respectively). Conclusion: LMR and SII are of significant values in clinical prognostic evaluation for patients with brain metastases from NSCLC.

Lymphocyte-monocyte ratio as a predictive marker for pathological complete response to neoadjuvant therapy in esophageal squamous cell carcinoma

Background

The hematological markers of systemic inflammation has been proved to be significantly associated with clinical outcomes in esophageal cancer. This retrospectively study was to evaluate the value of the hematological markers in predicting pathological complete response (pCR) and overall survival (OS) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) who received neoadjuvant chemoradiotherapy (nCRT).

Methods

A total of 87 patients with newly diagnosed LA-ESCC were retrospectively analyzed. The pretreatment lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were selected as hematological markers.

Results

After nCRT, 26 (29.9%) patients achieved pCR and 61 (70.1%) patients had non-pCR. The LMR was significantly higher in patients who achieved pCR compared to that in patients who did not achieve pCR (4.35±1.68 vs. 3.33±1.13, P=0.002). Based on the receiver operating characteristic (ROC) curve, the optimal cut off value of LMR that predicted pCR was 3.73 [area under the curve: 0.712; 95% confidence interval (CI): 0.594–0.830; P=0.002], with a sensitivity of 65.4% and specificity of 77.0%. The pCR rate of patients with LMR ≥3.73 was 53.1%, while the pCR rate of patients with LMR <3.73 was only 16.4% (P<0.001). The univariate and multivariate logistic regression analysis confirmed that LMR was an independent predictor of pCR [odds ratio: 5.093; 95% CI: 1.658–15.646; P=0.004]. However, in the prediction of OS, a multivariate Cox proportional hazard model revealed that only clinical stage [hazard ratio (HR): 1.970; 95% CI: 1.144–3.391; P=0.014] and pCR (HR: 0.469; 95% CI: 0.237–0.928; P=0.030) were independent prognostic factors.

Conclusions

Pre-treatment LMR may predict pCR in LA-ESCC patients who were treated with nCRT. Having pCR is an independent prognostic factor for prolonged survival.

Pineal gland protects against chemically induced oral carcinogenesis and inhibits tumor progression in rats

Clinical investigations suggest that melatonin suppression and circadian dysfunction may be related to cancer development in shift workers. Studies also show that melatonin suppression after pinealectomy increases cancer incidence in preclinical models. However, no study evaluated the influence of pinealectomy on oral cancer development. In the current study, we investigated the effects of pinealectomy on oral squamous cell carcinoma (OSCC) occurrence and progression in rats. Rats submitted to sham surgery were used as control. Pinealectomy promoted an increase of 140% in OSCC occurrence when compared to sham animals. Tumors from pinealectomized rats displayed a higher volume and thickness than the tumors from sham-operated animals. Pinealectomy induced atrophy of the epithelium adjacent to the oral lesions. Pinealectomized rats showed higher mean number of tumor-associated macrophages and eosinophils in the invasive front of OSCC. In addition, nuclear overexpression of ERK1/2 and p53 was also observed in the front of carcinomas from pinealectomized rats. These results reveal that pineal gland plays a protective role against oral carcinogenesis. The melatonin suppression caused by the pinealectomy might contribute to oral cancer development by acting on ERK1/2 and p53 pathways and regulating tumor inflammation.