Proposed new prognostic model using the systemic immune-inflammation index for primary central nervous system lymphoma: A prospective-retrospective multicohort analysis

Prognostic Assessment in Patients With Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System Using MRI-Based Radiomics

BACKGROUND

Primary central nervous system lymphoma (PCNSL) carries a poor prognosis. Radiomics may hold potential value in prognostic assessment.

PURPOSE

To develop and validate an MRI-based radiomics model and combine it with clinical factors to assess progression-free survival (PFS) and overall survival (OS) of patients with PCNSL.

STUDY TYPE

Retrospective and prospective.

POPULATION

Three hundred seventy-nine patients (179 female, 53 ± 7 years) from 2014 to 2022.

FIELD STRENGTH/SEQUENCE

T2/fluid-attenuated inversion recovery, contrast-enhanced T1WI and diffusion-weighted echo-planar imaging sequences on 3.0 T.

ASSESSMENT

Radiomics features were extracted from enhanced tumor regions on preoperative multi-sequence MRI. Using a least absolute shrinkage and selection operator (LASSO) Cox regression model to select radiomic signatures in training cohort (N = 169). Cox proportional hazards models were constructed for clinical, radiomics, and combined models, with internal (N = 72) and external (N = 32) cohorts validating model performance.

STATISTICAL TESTS

Chi-squared, Mann-Whitney, Kaplan-Meier, log-rank, LASSO, Cox, decision curve analysis, time-dependent Receiver Operating Characteristic, area under the curve (AUC), and likelihood ratio test. P-value <0.05 was considered significant.

RESULTS

Follow-up duration was 28.79 ± 22.59 months (median: 25). High-risk patients, determined by the median radiomics score, showed significantly lower survival rates than low-risk patients. Compared with NCCN-IPI, conventional imaging and clinical models, the combined model achieved the highest C-index for both PFS (0.660 internal, 0.802 external) and OS (0.733 internal, 0.781 external) in validation. Net benefit was greater with radiomics than with clinical alone. The combined model exhibited performance with AUCs of 0.680, 0.752, and 0.830 for predicting 1-year, 3-year, and 5-year PFS, and 0.770, 0.789, and 0.863 for OS in internal validation, with PFS AUCs of 0.860 and 0.826 and OS AUCs of 0.859 and 0.748 for 1-year and 3-year survival in external validation.

DATA CONCLUSION

Incorporating a multi-sequence MR-based radiomics model into clinical models enhances the assess accuracy for the prognosis of PCNSL.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 2.

Prognostic value of serum inflammatory markers in patients with esophageal squamous cell carcinoma undergoing surgery: a two-center retrospective cohort study

BACKGROUND AND PURPOSE

The combined assessment of the neutrophil-platelet score and prognostic nutritional index is yet to be applied in evaluating the prognosis of patients following an operation for esophageal cancer. This study aimed to identify independent prognostic factors for patients undergoing operation for esophageal cancer and to construct a nomogram model for predicting median overall survival (mOS).

METHODS

A cohort of 660 patients with esophageal cancer from two clinical centers in China was recruited, comprising a training cohort (n = 511) and a validation cohort (n = 149). Survival rates were compared using Kaplan-Meier curves and the log-rank test. The Cox regression model was used to identify independent prognostic factors.

RESULTS

The Multi-variable Cox regression analysis revealed that tumor, node, metastasis stage, smoking status, neutrophil-platelet score, and prognostic nutritional index were independent postoperative prognostic factors for patients with esophageal cancer (P < 0.05). The mOS (129.0 months, 95% confidence interval (CI) not reached) was significantly higher in patients with a low neutrophil-platelet score than those with a high score (43.0 months, 28.1-57.9; P < 0.05). Conversely, the mOS (42.0 months, 95% CI 6.7-55.2) was lower in the low prognostic nutritional index score group than the high score group (125.0 months, 95% CI 96.4-153.6; P < 0.05). Evaluation metrics, including the concordance index (0.69 in the training group and 0.70 in the validation group), receiver operator characteristic curve analysis (In the training cohort, the AUCs for predicting 1-, 3-, 5- and 10-year overall survival rates using the nomogram were 76.19%, 69.07%, 70.12% and 68.17%, respectively; in the validation cohort, the corresponding predicted values were 76.66%, 77.18%, 75.04% and 79.57%, respectively), calibration curve, and decision curve analysis, demonstrated the clinical utility of the constructed prediction model.

CONCLUSIONS

Serving as systemic inflammatory biomarkers, the neutrophil-platelet score and prognostic nutritional index offer valuable prognostic insights for patients with esophageal cancer, augmenting predictive capabilities.

Association between systemic immune-inflammation index and the risk of all-cause, cancer and non-cancer mortality in the general population: results from national health and nutrition examination survey 2005-2018

BACKGROUND

Inflammation plays an important role in the progression of cancer and other diseases, such as diabetes and cardiovascular and cerebrovascular diseases. The systemic immune-inflammation index (SII) was recognized as an objective biomarker reflecting immunoinflammatory status. This study aimed to identify the association between SII with all-cause, cancer and non-cancer mortality among general population in the United States.

METHODS

25,955 participants (≥ 20 years) were included from 2005 to 2018 National Health and Nutrition Examination Survey (NHANES) and were divided into four groups according to the SII quartiles. Weighted multivariate Cox regression was used to assess the correlation between SII and mortality. Subgroup analyses were conducted to identify the effects of other covariates on the relationship between SII and mortality. A restricted cubic spline (RCS) model was subsequently used to explore the dose-response relationship between SII and mortality. Survival analysis was assessed using Kaplan-Meier method.

RESULTS

In fully adjusted model, the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of individuals in Q4 were 1.24 (1.09, 1.41) for all-cause mortality and 1.41 (1.23, 1.63) for non-cancer mortality compared with Q1. Besides, the aHR and 95% CIs in Q2 of SII were 0.70 (0.50, 0.99) and in Q3 were 0.68 (0.52, 0.87) compared with Q1 for cancer mortality. In RCS analysis, non-linear relationships of J-shaped curves were observed in the association between SII with all-cause and non-cancer mortality. Additionally, a U-shaped curve was identified between SII and cancer mortality with a threshold value of 445.22.

CONCLUSION

Our findings imply that SII can serve as a potential prognosis indicator among general population. Elevated SII is associated with higher all-cause and non-cancer mortality. Furthermore, both the lowest and highest quartiles of the SII exhibit a correlation with heightened cancer mortality.

Diagnostic value of baseline 18 F-FDG PET/CT and peripheral blood inflammatory markers for aggressive lymphoma in non-Hodgkin's lymphoma

PURPOSE

This study aims to investigate the diagnostic value of baseline F18 fluorodeoxyglucose (FDG) PET/computed tomography (CT) parameters and peripheral blood inflammatory markers in aggressive lymphoma of non-Hodgkin lymphoma (NHL) and the correlation between peripheral blood inflammatory markers and maximum standardized uptake value (SUV max ).

PATIENTS AND METHODS

We conducted a retrospective analysis including 121 patients with NHL. Patients were divided into aggressive lymphoma group and indolent lymphoma group. Mann-Whitney U test, chi-square test and multivariate stepwise logistic regression were used to analyse. Subsequently, receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic performance. Additionally, Spearman correlation analysis was utilized to explore the correlation between peripheral blood inflammatory markers and SUV max .

RESULTS

Leptin mass criterion uptake value (SUL) max , SUV max , SUV avg , SUV peak , focal SUV max /liver SUV max , focal SUV max / mediastinal SUV max , SUL avg , SUL peak , systemic immune-inflammation (SII), neutrophil ratio, total lesion glycolysis (TLG), neutrophils versus lymphocyte ratio (NLR), plateletto-lymphocyte ratio (PLR), lactate dehydrogenase (LDH) and lymphocyle ratio between two groups were statistically significant ( P  < 0.05). SUV max was an independent influencing factor, and the area under the ROC curve was 0.862. There was a positive correlation between the PLR and SUV max ( r  = 0.239; P  = 0.008).

CONCLUSION

PET/CT parameters and peripheral blood inflammatory markers have certain value in the diagnosis of aggressive lymphoma in NHL, among which SUV max is an independent influencing marker and is positively correlated with PLR.

Letter to editor: C‑reactive protein levels, the prognostic nutritional index, and the lactate dehydrogenase‑to‑lymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a single‑center study of 223 patients

This critique evaluates a letter to the editor discussing prognostic factors in primary central nervous system lymphoma (PCNSL), focusing on C-reactive protein (CRP) levels, prognostic nutritional index (PNI), and lactate dehydrogenase (LDH)-to-lymphocyte ratio. While the letter provides valuable insights, limitations including reliance on a single-center dataset, lack of consideration for potential confounders, insufficient contextualization within existing literature, and limited discussion of clinical implications are identified. Addressing these limitations is crucial for enhancing the relevance and applicability of the findings in PCNSL management.

Nomograms integrating the collagen signature and systemic immune-inflammation index for predicting prognosis in rectal cancer patients

BACKGROUND

This study aimed to develop and validate a model based on the collagen signature and systemic immune-inflammation index to predict prognosis in rectal cancer patients who underwent neoadjuvant treatment.

METHODS

Patients with rectal cancer who had residual disease after neoadjuvant treatment at two Chinese institutions between 2010 and 2018 were selected, one used as a training cohort and the other as a validation cohort. In total, 142 fully quantitative collagen features were extracted using multiphoton imaging, and a collagen signature was generated by least absolute shrinkage and selection operator Cox regression. Nomograms were developed by multivariable Cox regression. The performance of the nomograms was assessed via calibration, discrimination and clinical usefulness. The outcomes of interest were overall survival and disease-free survival calculated at 1, 2 and 3 years.

RESULTS

Of 559 eligible patients, 421 were selected (238 for the training cohort and 183 for the validation cohort). The eight-collagen-features collagen signature was built and multivariable Cox analysis demonstrated that it was an independent prognostic factor of prognosis along with the systemic immune-inflammation index, lymph node status after neoadjuvant treatment stage and tumour regression grade. Then, two nomograms that included the four predictors were computed for disease-free survival and overall survival. The nomograms showed satisfactory discrimination and calibration with a C-index of 0.792 for disease-free survival and 0.788 for overall survival in the training cohort and 0.793 for disease-free survival and 0.802 for overall survival in the validation cohort. Decision curve analysis revealed that the nomograms could add more net benefit than the traditional clinical-pathological variables.

CONCLUSIONS

The study found that the collagen signature, systemic immune-inflammation index and nomograms were significantly associated with prognosis.

Interplay of Systemic Immune-Inflammation Index and Serum Klotho Levels: Unveiling a New Dimension in Rheumatoid Arthritis Pathology

Aim: The association between the systemic immune-inflammation index (SII) and serum Klotho concentrations (pg/ml) in patients with rheumatoid arthritis (RA) has not been elucidated. The purpose of this study was to clarify the relationship between the SII and serum Klotho concentrations in RA patients. Methods: All data come from the National Health and Nutrition Examination Survey (NHANES) database in the United States, which included 982 RA patients (age range: 40 to 79 years). The measurement data of the SII and serum Klotho are all from the NHANES mobile examination centre. We constructed a multivariate linear regression model to evaluate the association between the SII and serum Klotho levels in RA patients and conducted a subgroup analysis to test the stability of the statistical results. Results: Multivariate linear regression results indicated a negative linear relationship between the SII and serum Klotho concentrations in RA patients (β = -6.33, 95% CI [confidence interval]: -10.15 to -2.53). Compared to the quartile 1 group, the quartile 4 group was associated with significantly lower (P<0.001) serum Klotho concentrations (β = -120.93, 95% CI: -174.84 to -67.02). Compared with the quartile 1 group, with the increase in the SII, the β value showed a decreasing trend (P trend < 0.001). The subgroup analysis showed that none of the covariates affected the stability of these results (all P for interaction ≥ 0.05). Conclusion: There is a significant negative linear association between the SII and serum Klotho concentrations in RA patients. The SII can serve as a predictive indicator of serum Klotho concentrations in RA patients, and Klotho may be a potential anti-inflammatory target for RA treatment.

C-reactive protein levels, the prognostic nutritional index, and the lactate dehydrogenase-to-lymphocyte ratio are important prognostic factors in primary central nervous system lymphoma: a single-center study of 223 patients

Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive type of extranodal non-Hodgkin lymphoma (NHL), and the prognosis is poor. Currently, the most used prognostic models are the Memorial Sloan-Kettering Cancer Center (MSKCC) and International Extranodal Lymphoma Study Group (IELSG) scores; however, their predictive effects are changing with increasing incidence and changing treatment regimens. A growing body of evidence has demonstrated that inflammatory and nutritional markers are factors that can determine tumor prognosis. Therefore, the aim of this study was to identify and validate novel prognostic factors for PCNSL. Clinical information was collected from 223 patients with PCNSL. Patients younger than 18 years of age were excluded. Progression-free survival (PFS) and overall survival (OS) were used as endpoints, and receiver operating characteristic (ROC) curve analyses were conducted to determine the cutoff values for the inflammatory indicators. Correlations between variables and PFS or OS were assessed using univariate and multivariate analyses, and positive indicators were selected for survival analysis. A prognostic nutritional index (PNI) < 49.38 was associated with worse PFS (p = 0.003), and outcomes significantly differed between patients with a PNI ≥ 49.38 and < 49.38 (p < 0.001). Age < 60 years (p < 0.001) and C-reactive protein (CRP) levels < 3.14 (p = 0.001) were associated with better OS. In elderly patients (≥ 60 years), a lactate dehydrogenase-to-lymphocyte ratio (LLR) < 95.69 (p = 0.021) was associated with better OS, and the outcome significantly differed between patients with an LLR ≥ 95.69 and LLR < 95.69 (p = 0.015). The PNI and CRP levels are prognostic factors for PCNSL, and CRP was the first time shown to be a prognosis factor of PCNSL. In elderly patients with PCNSL, the LLR can predict prognosis.

An elevated systemic inflammation index is related to an inferior response to pomalidomide and dexamethasone treatment in patients with relapsed and refractory multiple myeloma

Introduction

The systemic inflammation index (SII) might serve as an indicator of the equilibrium between the inflammatory and immune responses. The aim of the study was to determine the clinical value and prognostic significance of SII in the cohort of multiple myeloma (MM) patients treated with a regimen of pomalidomide and dexamethasone (Pd).

Material and methods

This retrospective, real-life study included patients who received a Pd regimen in our centre between November 2018 and July 2022. The systemic inflammation index was calculated from peripheral blood counts of platelets, neutrophils, and lymphocytes collected shortly before commencement of Pd treatment using the equation: SII = N × P/L, where N, P, and L are the respective counts per litre of peripheral blood for neutrophils, platelets, and lymphocytes.

Results

The study group consisted of 54 patients. Most patients received Pd as the third (38.9%) or fourth (37.0%) line of treatment. The median number of completed treatment cycles was 5 (IQR: 1-12). The median progression-free survival (PFS) was 6.8 months and overall survival (OS) 14.8 months. High SII (> 374) was an independent prognostic factor for PFS (HR = 3.0, 95% CI: 1.4-6.3, p < 0.01) and OS (HR = 2.2, 95% CI: 1.0-4.6, p = 0.04). In the low SII group, the respective median PFS and OS values were 9.6 and 21.7 months, compared to 2.6 (p = 0.018) and 5.5 months (p = 0.035) in the high SII group.

Conclusions

The systemic inflammation index has prognostic significance in MM patients treated with Pd. A high SII predicts a poorer outcome in pretreated MM patients undergoing Pd treatment evaluation. As such, it may well be a key factor for guiding subsequent treatment decisions.

Development and Validation of Pretreatment Serum Total Bilirubin as a Biomarker to Predict the Clinical Outcomes in Primary Central Nervous System Lymphoma: A Multicenter Cohort Study

Primary central nervous system lymphoma (PCNSL) is a predominantly aggressive neoplasm isolated to the central nervous system or vitreoretinal space. Bilirubin is an important biomarker reflecting hepatic function and oxidative stress status that is associated with the occurrence and development of various tumors. However, its prognostic role in PCNSL has yet to be evaluated. Therefore, we conducted a prospective-retrospective study to analyze the predictive value of serum total bilirubin (STB) in PCNSL patients. The association between the pretreatment STB and clinical outcomes in PCNSL was developed in the discovery cohort (retrospective [n = 44] and prospective [n = 45]) and validated in an independent retrospective cohort (n = 69). A generalized additive model, Kaplan-Meier curve, and Cox analysis were applied. In the discovery cohort, the STB showed a linear relationship with overall survival (OS, p = 0.011) and progression-free survival (PFS, p = 0.0476). The median STB level of 12.0 µmol/L was determined as the cutoff value to predict the clinical outcomes with area under the receiver operating characteristic curve (AUROC) values of 0.9205 and 0.8464 for OS and PFS, respectively. The median STB level resulted in similar accuracy for predicting the clinical outcomes in the validation cohort with AUROC values of 0.8857 and 0.8589 for OS and PFS, respectively. In both the discovery and validation cohorts, the Kaplan-Meier survival curve and Cox regression analysis showed that the upper median STB groups showed significantly worse OS than the lower median STB groups. In conclusion, the pretreatment STB could be considered a novel biomarker to predict the clinical outcomes in patients with PCNSL receiving high-dose methotrexate-based combination immunochemotherapy.