Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab

The value of peripheral blood inflammation markers in risk assessment and prediction of lung cancer

BACKGROUND

Lung cancer has high mortality rates globally, with inflammatory processes playing a pivotal role in NSCLC progression. Peripheral blood inflammation markers offer promise for NSCLC risk assessment and prediction.

METHODS

A retrospective case-control study included 50 NSCLC patients and 50 healthy individuals admitted for routine health examinations as controls. Clinical data were collected, and blood routine tests were conducted on the first day of admission. We compared white blood cells, neutrophils, lymphocytes, monocytes, platelets, NLR (Neutrophil-to-Lymphocyte Ratio), LMR (Lymphocyte-to-Monocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio), dNLR (derived NLR), and SII (Systemic Immune-inflammation Index). Logistic regression and ROC curve analysis were used to evaluate their predictive value.

RESULTS

NLR was significantly higher in NSCLC patients than in healthy controls, and elevated NLR was strongly associated with increased odds of having NSCLC. Neutrophil, lymphocyte, and monocyte counts also contributed to the odds of having NSCLC. NLR showed the highest predictive value with an AUC of 0.911, indicating excellent accuracy.increased odds of having NSCLC.

CONCLUSIONS

Our findings suggest that peripheral blood inflammation markers, particularly the NLR, may have potential utility in risk assessment and prediction for NSCLC. These markers warrant further investigation to explore their potential role in early diagnosis and monitoring of NSCLC.

Machine learning driven prediction of drug efficacy in lung cancer: based on protein biomarkers and clinical features

Currently, chemotherapy drugs are the first-line treatment for lung cancer patients, and evaluating their efficacy is of utmost significance. However, assessing the clinical efficacy of chemotherapy drugs remains a challenging task. In recent years, machine learning, especially artificial intelligence (AI), has emerged as a transformative tool in the field of oncology, capable of integrating multiple clinical and protein biomarkers for more accurate predictions. The study collected clinical data and hematological parameters from 2115 lung cancer patients at Hubei Cancer Hospital. Ten typical machine learning models were selected to predict overall survival and progression-free survival, including Decision Tree, Random Forest, Logistic Regression, k-Nearest Neighbors, AdaBoost, XGBoost, and CatBoost. The study found that the CatBoost model performed best in predicting 3-year overall survival and progression-free survival, with AUCs of 0.97 (0.95-0.99) or 0.95 (0.92-0.98). Additionally, the study further analyzed the performance of different machine learning models in patient mortality risk stratification. The CatBoost model excelled in distinguishing between high-risk and low-risk patients, which demonstrated outstanding performance in survival rate prediction at various time points, particularly in predicting survival rates at 1 year (0.54, 0.68), 3 years (0.05, 0.27), and 5 years (0.01, 0.07). The results showed that these models performed well in distinguishing high-risk from low-risk patients, especially the CatBoost model. Therefore, we suggest that these models, particularly the CatBoost model, could serve as practical clinical prediction tools to assist clinicians in developing better and more reasonable treatment plans.

Prognostic Role of Systemic Inflammatory Markers in Pediatric Soft-Tissue Sarcoma: A Multicenter Study of 213 Patients

BACKGROUND

The prognostic role of systemic inflammation markers in pediatric soft-tissue sarcomas (STS) remains unclear.

PROCEDURE

This multicenter study investigated the prognostic significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), C-reactive protein (CRP), and lactate dehydrogenase (LDH) in 213 pediatric patients diagnosed with STS in years 2002-2023. Patients were categorized into groups: rhabdomyosarcoma (RMS, n = 126), RMS-like (n = 57), and non-RMS (n = 30). Clinicopathological data, including complete blood counts (CBCs), CRP, and LDH levels, were collected and age-adjusted. Optimal cutoffs for predicting outcomes were determined, and the prognostic value of the inflammatory markers was assessed using Kaplan-Meier survival analysis, log-rank tests, and Cox regression models.

RESULTS

No significant differences in NLR, PLR, LMR, and CRP levels were observed between RMS, RMS-like, and non-RMS groups. However, LDH levels were significantly elevated in the RMS group compared with the RMS-like group. A consistent trend toward higher NLR, PLR, and CRP values was noted in patients with more advanced disease stages. Multivariate Cox regression analysis across the entire cohort identified CRP (HR 3.39, 95% CI 1.55-7.4, p = 0.002), NLR (HR 2.06, 95% CI 1.07-3.99, p = 0.03), and disease stage (HR = 0.49, 95% CI 0.26-0.95, p = 0.035) as independent prognostic factors for survival. Subgroup analyses revealed that the prognostic impact of these markers varied across histopathological subtypes, with limited utility in the RMS-like group.

CONCLUSIONS

These findings highlight the prognostic value of systemic inflammatory markers in pediatric STS, emphasizing their potential to refine risk assessment and guide treatment.

Systemic immune-inflammation index as a predictor of survival in non-small cell lung cancer patients undergoing immune checkpoint inhibition: A systematic review and meta-analysis

BACKGROUND

This meta-analysis aims to evaluate the association between pretreatment systemic immune-inflammation index (SII) levels and progression-free survival (PFS) and overall survival (OS) in NSCLC patients receiving immune checkpoint inhibitors (ICIs).

METHODS

A systematic search was conducted across PubMed, Embase, and Web of Science. Hazard ratios (HRs) with 95 % confidence intervals (CIs) for PFS and OS were extracted or calculated. Random-effects models were employed to pool the results and subgroup analyses were performed based on study characteristics, treatment regimens, and analytical methods.

RESULTS

Two prospective and 11 retrospective studies involving 2342 NSCLC patients treated with ICIs were included. A high pretreatment SII was significantly associated with poor PFS (HR: 2.05, 95 % CI: 1.59-2.64, p < 0.001; I2 = 42 %) and poor OS (HR: 1.54, 95 % CI: 1.29-1.82, p < 0.001; I2 = 22 %). Subgroup analyses according to the country of the study, lines of treatment, cancer stage, methods for determining the cutoffs of SII, and the analytic models showed consistent results (p for subgroup difference all > 0.05). Interestingly, the subgroup analyses indicated a stronger association in patients receiving ICIs alone versus those receiving concurrent chemotherapy (p for subgroup difference = 0.04).

CONCLUSIONS

High pretreatment SII is associated with worse PFS and OS in NSCLC patients treated with ICIs, particularly for the patients receiving ICIs alone without concurrent chemotherapy.

Nutritional and inflammatory indicators differ among patients with colorectal cancer with distinct microsatellite stability statuses

BACKGROUND

Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer, which are factors closely associated with the diagnosis and treatment of colorectal cancer (CRC).

AIM

To explore the relationship between nutritional and inflammatory indicators and microsatellite stability (MSS) status in CRC.

METHODS

The clinical data of 56 patients who underwent surgical treatment for CRC were collected. Furthermore, the expressions of nutritional (levels of serum albumin, triglycerides, serum cholesterol, and body mass index) and inflammatory response indicators (absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio) as well as their correlation with microsatellite instability (MSI) status were investigated in patients with CRC.

RESULTS

Compared to the patients with MSS tumors, those with MSI tumors demonstrated significantly lower levels of two nutritional indicators, namely serum albumin and body mass index (P < 0.05). Moreover, patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group (P < 0.05), indicating pronounced differences in inflammatory responses and immune states between the two groups.

CONCLUSION

Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC, highlighting their potential role in the clinical treatment and health management of this specific population.

Novel Composite Scoring System for Predicting Prognosis in Stage IV Gastric Cancer Patients Treated with Immune Checkpoint Inhibitors

Background

Gastric cancer (GC) with distant metastases has a poor prognosis, and immune checkpoint inhibitors (ICIs) effectively improve the survival time of patients with this disease. This study aimed to identify effective prognostic markers that can predict the treatment effect of ICIs in patients with stage IV GC.

Methods

This study included 256 patients with GC with distant metastases who had received treatment with ICIs. A receiver operating characteristic (ROC) curve was used to analyze the predictive ability and optimal cutoff values of immune-inflammatory markers. Kaplan‒Meier survival curves were used to analyze the differences in progression-free survival (PFS) and overall survival (OS) among patients. Cox proportional hazard regression analysis was used to identify independent prognostic factors for PFS and OS.

Results

By comparing the area under the ROC curve (AUC) of immune-inflammatory markers, we selected the preoperative platelet count/(lymphocyte count × prealbumin count) ratio and fibrinogen/albumin ratio to form a combined score (PLPR-FAR score). The ROC curve revealed that when the PLPR-FAR score was used to predict patient PFS and OS, the AUC were 0.614 and 0.672, respectively. The Kaplan‒Meier survival curve revealed that patients with higher PLPR-FAR scores had significantly shorter PFS and OS than those with lower PLPR-FAR scores. Cox proportional hazard regression analysis revealed that the PLPR-FAR score was an independent risk factor for PFS and OS in stage IV GC patients.

Conclusion

The PLPR-FAR score may help identify which patients are more likely to benefit from ICIs treatment, and could serve as a novel and promising prognostic biomarker.

Novel non-curable resection prediction model for early colorectal cancer following endoscopic submucosal dissection based on inflammatory immune index

Backgrounds

Colorectal carcinoma represents one of the common malignant tumors of digestive tract in clinic. Systemic immune inflammation index (SII) has great potential in predicting prognosis of digestive tract tumors. We sought to explore the predictive ability of SII for non-curative resection of early colorectal cancer treated with ESD, and to establish a related predictive model.

Methods

A retrospective analysis was performed on data from patients with early-stage colorectal cancer who underwent ESD in our hospital between January 2019 and December 2022. To establish the optimal cut-off value for the SII, Receiver Operating Characteristic (ROC) curves were generated, correlating preoperative SII levels with postoperative resection outcomes. Patients were categorized into high SII and low SII groups, and their clinical characteristics were comparatively analyzed. Furthermore, patients were stratified according to the presence or absence of non-curative resection outcomes post-ESD, to identify independent risk factors associated with non-curative resection. A prognostic nomogram was subsequently developed to enhance predictive accuracy for non-curative resection, integrating identified risk variables.

Results

A total of 215 patients were enrolled in this study, all of whom successfully underwent ESD, achieving an en bloc resection rate of 96.7%. Based on surgical procedures and pathological resection characteristics, 181 cases were classified as curative resections, whereas 34 cases of non-curative resections. Postoperative complications occurred in 10 patients, resulting in a complication rate of 4.7%. The optimal cut-off value of SII was 629.2 × 10∧9/L (area under the curve: 0.762, P < 0.001), and the sensitivity and specificity was 64.7 and 85.6%, respectively. An optimal SII cut-off value for predicting non-curative resection was determined to be 1.56 (AUC: 0.571, 95% CI: 0.501-0.641). Multivariate analysis demonstrated that elevated SII (P = 0.002), a positive lifting sign (P = 0.003), increased tumor size (P = 0.034), and poor tumor differentiation (P < 0.001) were independent risk factors significantly associated with non-curative resection.

Conclusion

SII revealed well correlation in predicting non-curable resection in patients with early colorectal cancer treated by ESD. Meanwhile, the higher the patient's NLR, PLR, tumor diameter and infiltration depth, the more likely to occur postoperative non-curative resection.

Relationship between the systemic immune-inflammatory index and overactive bladder risk: A cross-sectional assessment involving United States Adults

AIMS

This study aimed to evaluate the association between the systemic immune-inflammatory index (SII) and the risk of overactive bladder (OAB) in the adult United States population.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 were analyzed. A non-pregnant cohort aged ≥20 years with available SII and OAB data was included. Weighted univariate and multivariate logistic regression analyses were performed to assess the association between SII and OAB risk. Additionally, subgroup, interaction, and restricted cubic spline analyses were conducted.

RESULTS

A total of 4,545 participants were included, of whom 16.13% had OAB, with a mean SII of 5.75 ± 0.07. OAB risk increased with higher SII tertiles. In the fully adjusted model (Model 2), individuals in the highest SII tertile exhibited a 41% higher risk of OAB compared to those in the lowest tertile (OR: 1.41, 95% CI: 1.13-1.76, P = 0.004). Two-piece-wise regression analysis identified an SII breakpoint at 3.40, where a significant positive association was found for SII ≥ 3.40 (OR = 1.06, P < 0.0001), whereas no significant association was detected for SII < 3.40 (P = 0.06). Subgroup and interaction analyses revealed a consistent relationship between SII and OAB across different population strata, except for diabetes mellitus.

CONCLUSION

SII, an easily accessible biomarker, was independently associated with an increased risk of OAB, highlighting its potential utility in diagnostic prediction.

Increased Systemic Immune-Inflammatory Index and Association with Occult Nodal Disease in Non-Small Cell Lung Cancer

BACKGROUND

It has been proposed that more aggressive tumors trigger a stronger inflammatory response than less aggressive types. We hypothesize that systemic immune-inflammatory index (SII) is associated with occult nodal disease (OND) in clinically node-negative patients undergoing lung resection for non-small cell lung cancer (NSCLC).

STUDY DESIGN

The study included patients who underwent lung resection with nodal dissection, according to current guidelines, at a single center between 2010 and 2021 for NSCLC. Preoperative SII within 3 weeks of surgery was calculated. OND was defined as a clinically node-negative patient found to be pathologically node-positive. Cut-point analysis for SII was performed to identify the level most strongly associated with OND. Univariable and multivariable logistic regressions were used to examine the association between SII, clinical factors, and OND.

RESULTS

A total of 199 patients met inclusion criteria, of whom 51% (102 of 199) were women. The median number of nodes and nodal stations examined was 13 (interquartile range 9 to 17) and 6 (interquartile range 5 to 6), respectively. The cut point was determined to be SII 112 or more. On univariable analysis, high SII was associated with OND (odds ratio 15.75, 95% CI 2.09 to 118.73, p = 0.007). On multivariable analysis, after controlling for age, BMI, approach, sex, smoking history (pack-years), forced expiratory volume in 1 second, performance status, comorbidity, histology, lymphovascular invasion, tumor differentiation, and tumor size, high SII was associated with OND (odds ratio 34.59, 95% CI 2.69 to 444.88, p = 0.007).

CONCLUSIONS

Increased SII is associated with OND in patients undergoing lung resection for NSCLC.

Clinical outcomes, toxic effect, and immune microenvironment changes of drug-eluting bead bronchial arterial chemoembolisation/bronchial arterial chemoembolization combined with immunotherapy in treating elderly patients with non-small cell lung cancer

AIM

Systemic chemotherapy plus immune checkpoint inhibitors (ICIs) are first-line treatment for advanced non-small cell lung cancer (NSCLC). However, elderly patients typically have comorbidities that tend to limit the use of chemotherapy at standard dosage and frequency. Drug-eluting bead bronchial arterial chemoembolisation (DEB-BACE)/bronchial arterial chemoembolization (BACE) represents options in such patients.

MATERIALS AND METHODS

This is a retrospective analysis. We screened all elderly patients (aged ≥70 years) undergoing treatment with immunotherapy plus DEB-BACE/BACE for pathologically confirmed stage III-IV NSCLC with negative driver gene mutations from October 2019 to December 2023 at our hospital. The response was evaluated according to the Response Evaluation Criteria in Solid Tumors version 1.1 criteria.

RESULTS

The final analysis included 46 patients (median age: 76 years; 42 men and 4 women). Eastern Cooperative Oncology Group (ECOG) performance status was either 1 or 2. The median progression-free survival and overall survival were 9.1 months (95% confidence interval [CI]: 8.4-9.9) and 18.2 months (95% CI: 16.5-19.9), respectively, after a median follow-up of 20.3 months (95% CI: 19.5-21.1) in all populations. The most prevalent adverse events (AEs) were myelosuppression (76.1%, 35/46), followed by decreased appetite (71.7%, 33/46), nausea (65.2%, 30/46), and fatigue (54.3%, 25/46). The rate of any grade and grade ≥3 immune-related AEs was 34.8% (16/46) and 6.5% (3/46), respectively. No patients experienced treatment-related deaths, haemoptysis, or unexpected embolisation.

CONCLUSION

DEB-BACE/BACE combined with immunotherapy was effective and well tolerated in elderly patients with advanced NSCLC.

The Impact of the Histologic Types of Lung Cancer on CBC-Derived Inflammatory Markers-Current Knowledge and Future Perspectives

Background/Objectives: The analysis of the complete blood count (CBC)-derived inflammatory indexes across different histological subtypes of lung cancer supports the early detection of tumor-induced inflammation and has a good predictive value for severity in cancer patients. The main objective of this article was to assess the variations in CBC-derived inflammatory markers across different histologic subtypes of lung cancer, with the final goal of identifying specific predictors of severity for each histologic subtype of lung cancer. Methods: We conducted a retrospective descriptive study that included 202 patients diagnosed with lung carcinoma at the Clinical County Hospital Mureș. The analyzed parameters were as follows: the histological type, the stage of the tumor, patients' general data, and associated comorbidities. In addition, nine CBC-derived inflammatory indexes, like the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-neutrophil ratio (ENR), eosinophil-to-monocyte ratio (EMR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI), were analyzed as predictors of severity and correlated with histologic findings. Results: The predictors of severity differed across the histologic subtypes. SIRI, d-NLR, and age were predictors of severity in adenocarcinoma patients, while the d-NLR, ENR, leukocyte, and neutrophil count predicted severity in squamous cell carcinoma. For SCLC patients, AISI, SIRI, SII, d-NLR, EMR, ENR, MLR, leukocyte count, lymphocyte count, neutrophil count, platelets count, COPD, smoking, and male gender were predictors for severity. Conclusions: Understanding the complexity and variations in the inflammatory response across different histologic types of lung cancer can personalize treatment regimens and target specific abnormal cellular lines, thus improving the outcome of this highly deadly condition.

Platelet-to-high-density lipoprotein ratio (PHR) as a predictive biomarker for gastrointestinal cancers: evidence from NHANES

BACKGROUND

Gastrointestinal (GI) cancers, including gastric, colorectal, and esophageal cancers, pose a significant global health burden. Despite advancements in diagnostic tools, early detection remains challenging, particularly in low-resource settings. Emerging evidence highlights the platelet-to-high-density lipoprotein ratio (PHR) as a novel biomarker integrating systemic inflammation and lipid metabolism. However, its association with GI cancer risk remains underexplored.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2010 to 2018, comprising 19,388 participants, including 230 with GI cancers. PHR was calculated as the ratio of platelet count to high-density lipoprotein cholesterol levels and categorized into quartiles. Weighted logistic regression models, restricted cubic spline analysis, and subgroup analyses were employed to evaluate the association between PHR and GI cancer risk, adjusting for demographic, socioeconomic, lifestyle, and clinical factors.

RESULTS

Elevated PHR was independently associated with an increased risk of GI cancers. Participants in the highest PHR quartile exhibited a significantly higher risk (adjusted OR = 3.09; 95% CI: 2.16-4.43) compared to the lowest quartile. A dose-response relationship was observed, with two critical inflection points at PHR values of 3.2 and 4.5. Subgroup analyses revealed stronger associations among older adults, males, and obese individuals. The findings suggest that PHR may reflect the dynamic balance of systemic inflammation and lipid metabolism, contributing to tumorigenesis.

CONCLUSION

This study identifies PHR as a promising, cost-effective biomarker for early detection and risk stratification of GI cancers. Its integration into screening programs could improve precision medicine strategies by identifying high-risk individuals for early intervention. Further longitudinal and mechanistic studies are warranted to confirm these findings and explore the underlying biological mechanisms.

The Association of Systemic Immune Inflammation Index (SII) and Platelet-to-Lymphocyte Ratio (PLR) on Coagulopathy and Prognosis in Patients with Traumatic Brain Injury

Objective

We aimed to investigate the associations between inflammatory immune indicators, specifically systemic immune inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and the coagulopathy and prognosis of traumatic brain injury (TBI) patients in ICU.

Methods

One hundred sixty-one TBI patients were grouped into four groups. The outcomes included TBI-related coagulopathy and prognosis at six months after discharge. The association between SII, PLR and coagulopathy, and prognosis in TBI patients was elucidated by applying trend analysis, sensibility analysis, spearman correlation, restricted cubic splines and so on.

Results

Sixty-four (39.75%) of 161 TBI patients were diagnosed with coagulopathy. In the unadjusted model, TBI patients in the lowest quarter of SII (≤966.60) and PLR levels (≤97.99) had a higher risk of coagulopathy than those in the highest quarter of SII (≥3096.16) [OR 0.169 (95% CI 0.052-0.547)] and PLR (≥255.39) [OR 0.098 (95% CI 0.028-0.340)]. After adjusting for covariates, the significant negative associations of results remained consistent in the sensitivity analyses. Restricted cubic splines revealed that an almost linear relationship between SII, PLR and coagulopathy risk and poor prognosis (P for all nonlinearities > 0.05). Finally, receiver operating characteristic (ROC) curves indicated that the SII and PLR had certain diagnostic and predictive values for TBI-related coagulopathy [AUC(SII) = 0.666 (95% CI 0.566-0.766), AUC(PLR) = 0.752 (95% CI 0.662-0.842)] and prognosis [AUC(SII) = 0.657 (95% CI 0.548-0.766), AUC(PLR) = 0.700 (95% CI 0.596-0.805)]. The stratification of isolated TBI and TBI with multi-trauma does not affect SII and PLR in predicting TBI-related coagulopathy and poor prognosis in the subgroup analysis (P > 0.05).

Conclusion

This study demonstrated that the SII and PLR had a significant correlation with coagulopathy risk and prognosis at 6 months after discharge. SII and PLR were predictive of coagulopathy and poor prognosis, specifically PLR value. It suggests that the SII and PLR might be promising biomarkers for predicting TBI-related coagulopathy and prognosis.

Trial Registration

The study was registered in the ethics committee of the Third Affiliated Hospital of Southern Medical University (2024-ER-005).

Prognostic role of inflammatory and tumor biomarkers in hilar cholangiocarcinoma patients receiving postoperative adjuvant therapy

Background

Hilar cholangiocarcinoma (HCCA) is an aggressive cancer with poor prognosis after surgery. The systemic immune-inflammation index (SII) has been proposed as a prognostic marker, but its relationship with other markers such as CA19-9 remains unclear. This study investigates the prognostic significance of SII and CA19-9 in HCCA patients receiving post-surgery adjuvant therapy.

Methods

A cohort of 145 HCCA patients who underwent surgery and adjuvant therapy was analyzed. Patients were categorized into High SII and Low SII groups based on an optimal cutoff value of 672.8, determined using ROC curve analysis. Further stratification was performed based on CA19-9 levels. The associations between SII, CA19-9, and survival outcomes, including overall survival (OS) and disease-free survival (DFS), were assessed using Kaplan-Meier survival analysis and Cox proportional hazards regression.

Results

Elevated SII was significantly associated with worse OS (p = 0.0027) and DFS (p = 0.0024). Notably, a significant difference in CA19-9 levels was observed between high and low SII groups (p = 0.013), with higher CA19-9 levels in the high SII group. However, no significant difference in CA19-9 was found between the low SII groups (p = 0.128). Patients with both high SII and high CA19-9 levels had the poorest survival outcomes, with significantly higher risks of mortality and disease recurrence (HR for OS = 2.29, 95% CI: 1.23-4.25; HR for DFS = 2.16, 95% CI: 1.17-3.99). Multivariate analysis identified high SII, high CA19-9, lymph node metastasis, and local organ metastasis as independent prognostic factors.

Conclusions

Elevated SII and CA19-9 are independent prognostic markers for HCCA patients after surgery. The combination of high SII and high CA19-9 identifies a subgroup with the poorest prognosis, suggesting the potential for these markers to guide postoperative treatment decisions.

Proportional Correlation Between Systemic Inflammation Response Index and Gastric Cancer Recurrence Time: A Retrospective Study

BACKGROUND

Disease recurrence is the primary cause of death in patients with gastric cancer who have undergone complete surgical resection. No prognostic factors for recurrence, other than the Tumor, Node, and Metastasis stage, have been established. However, recurrence rates differ even within the same Tumor, Node, and Metastasis stage. Therefore, we aimed to develop a new prognostic confidence measure for gastric cancer recurrence and demonstrate its practical utility.

METHODS

This was a retrospective study based on the medical records of the Chungnam National University Hospital, Republic of Korea. We enrolled patients diagnosed with stage II/III gastric cancer who underwent complete surgical resection and adjuvant chemotherapy over the past 12 years. The association between seven variables, including the systemic inflammation response index (SIRI) and gastric cancer recurrence, was analyzed.

RESULTS

A total of 296 patients were enrolled in this study. Although other factors did not exhibit significant correlations, SIRI showed a significant positive correlation with gastric cancer recurrence risk, confirmed through Cox regression testing (hazard ratio, 1.231; 95% confidence interval, 1.04-1.45). Linear regression analysis revealed a significant association between higher SIRI values and shorter recurrence time (p = 0.044; β = -0.225).

CONCLUSIONS

In this study, other than SIRI, effective prognostic factors related to gastric cancer recurrence were not verified, thus indicating SIRI as a potential independent prognostic factor.

Neutrophil-to-lymphocyte ratio as a prognostic marker for lung cancer in combined pulmonary fibrosis and emphysema patients

BACKGROUND

Combined pulmonary fibrosis and emphysema (CPFE) represents a distinct clinical syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis, with an increased risk of lung cancer (LC) development. This study aimed to detect the clinical features and prognosis of CPFE patients with LC and the ability of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in those individuals.

METHODS

A retrospective cohort study involving patients diagnosed with CPFE combined with LC between January 2017 and December 2023 was conducted. Clinical characteristics, laboratory parameters and survival data were collected.

RESULTS

A total of 80 CPFE patients with LC were included, with a mean age of 68.1 years, and a male predominance (93.8%). The LCs were predominantly adenocarcinomas (38.8%), with a significant proportion diagnosed at advanced stages (22.5% at stage III, 47.5% at stage IV) and preferential peripheral pulmonary localization (72.5%). CPFE patients with LC had estimated 1-year, 3-year, and 5-year survival rates of 52%, 40%, and 37%, respectively, with a median overall survival of 29.2 months. Multivariate Cox regression analysis revealed that increased NLR [adjusted hazard ratio (HR) 1.180, 95% confidence interval CI 1.029-1.352, p = 0.018] and elevated carcinoembryonic antigen (CEA) (adjusted HR 1.005, 95% CI 1.000-1.010, p = 0.036) were related to an enhanced risk of all-cause mortality. Receiver-operating characteristic analysis identified an NLR cutoff value of 2.6 as a predictor of all-cause death within 24 months [area under the curve = 0.651; specificity = 62.1%; sensitivity = 66.6%; p < 0.05]. Patients with an NLR greater than 2.6 had a significantly greater risk of all-cause death than those with an NLR of 2.6 or less (adjusted HR 2.3, 95% CI 1.197-4.754; p = 0.011).

CONCLUSIONS

The NLR may serve as a cost-effective and widely accessible biomarker for risk stratification, particularly in CPFE patients with advanced-stage LC. In our cohort, an NLR cutoff value of 2.6 provides improved prognostic accuracy in predicting mortality outcomes.

The Prognostic Value of the Systemic Immune-Inflammation Index in Glioblastoma Patients and the Establishment of a Nomogram

OBJECTIVE

The systemic immune-inflammation index (SII) has recently attracted significant interest as a new biomarker for predicting the prognosis of patients with glioblastoma (GBM). However, the predictive significance of it is still a subject of debate. This study intended to assess the clinical effectiveness of the SII in GBM and establish a nomogram.

METHODS

Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off values of the SII. Kaplan-Meier (KM) survival curves were used to analyze the median overall survival (OS). Cox regression analysis was carried out to evaluate the associations between OS and different clinical factors. Based on the SII and clinical characteristics, a nomogram was constructed, and its value in clinical application was evaluated by means of decision curve analysis.

RESULTS

The optimal SII cut-off value was 610.13. KM analysis revealed that GBM patients with higher SII values had shorter OS (15.0 vs. 34.0 months, P = 0.044). Multivariate analysis demonstrated that a high SII was an independent predictor of poor outcome in GBM (HR = 1.79, P = 0.029). The nomogram incorporating the preoperative SII showed good predictive accuracy for GBM patient prognosis (C-index = 0.691).

CONCLUSIONS

The SII is an independent predictive indicator for GBM. Patients with elevated SII levels tend to have a poorer prognosis. A nomogram combining the SII with clinical and molecular pathological features can assist clinicians in assessing the risk of death in GBM patients, providing a basis for individualized treatment decisions.

Neutrophil-to-lymphocyte ratio-based prognostic score can predict outcomes in patients with advanced non-small cell lung cancer treated with immunotherapy plus chemotherapy

BACKGROUD

Immune checkpoint inhibitor (ICI) plus chemotherapy has become the standard of care for advanced non-small cell lung cancer (NSCLC). Nonetheless, reliable efficacy biomarkers of ICI plus chemotherapy are lacking. In this research, we sought to explore efficacy biomarkers and construct robust prognostic models in NSCLC patients treated with ICI plus chemotherapy.

METHODS

We retrospectively analyzed 171 patients with advanced NSCLC treated with ICI plus chemotherapy. Clinical characteristics and peripheral blood inflammatory indexes were collected and prognostic models were constructed to explore efficacy and prognosis biomarkers of ICI plus chemotherapy.

RESULTS

In the cohort that received first-line ICI plus chemotherapy, pre-treatment neutrophil-to-lymphocyte ratio (NLR) > 3.3 and fibrinogen (FIB) > 3.196 were associated with worse efficacy and were independent risk factors of progression-free survival (PFS). Compared to programmed cell death ligand 1 (PD-L1), the derived NLR-FIB (NF) score had significantly improved accuracy in predicting efficacy and prognosis. In advanced NSCLC patients with targetable oncogenic driver alterations receiving second- or post-line ICI plus chemotherapy, pre-treatment NLR > 3.53 was associated with worse efficacy and was an independent risk factor of PFS and OS; Tyrosine kinase inhibitor (TKI)-PFS > 12 months were independent risk factors of overall survival (OS). Secondary epidermal growth factor receptor (EGFR)-T790M mutation, platelet-to-lymphocyte ratio (PLR) > 196.81 and albumin (ALB) < 40.25 were associated with worse PFS. Based on NLR and TKI-PFS, an NLR-TKI-PFS (NTP) score was constructed with three OS risk prognosis categories: favorable, intermediate, and poor (corresponding to a median OS of 21, 12, and 5.3 months).

CONCLUSIONS

The noninvasive NF score, combining NLR > 3.3 and FIB > 3.196, was superior to PD-L1 estimated from tumor tissue in predicting the efficacy and prognosis of first-line ICI plus chemotherapy in advanced NSCLC patients. The noninvasive NTP score, combining NLR > 3.53 and TKI-PFS > 12 months, is a valuable tool for predicting OS and PFS in advanced NSCLC patients with targetable oncogenic driver alterations receiving second- or post-line ICI combination therapy.

Delta-radiomics features combined with haematological index predict pathological complete response after neoadjuvant immunochemotherapy in resectable non-small cell lung cancer

AIM

This study aimed at assessing the value of enhanced computed tomography (CT)-based delta-radiomics features (Delta-RFs) and Delta-RFs combined with haematological dynamic changes in predicting pathological complete response (PCR) after neoadjuvant immunochemotherapy in non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

From January 2021 to August 2023, in total, 165 patients with stage IB-IIIB NSCLC (training, n=115, validation, n=50) who received neoadjuvant immunochemotherapy before surgery, were retrospectively enrolled. Radiomic features were extracted from tumour region of interest on pretreatment and pre-operation enhanced CT images. Delta-RFs are defined as the relative net change in radiomics features between pre-neoadjuvant immunochemotherapy and pre-operation stage. The least absolute shrinkage and selection operator was used to ensure optimal feature selection to calculate the radiomics score (Rad-score) for predicting PCR. Univariate and multivariate logistic regression analyses were performed to screen the factors related to PCR and predictive models were then constructed.

RESULTS

Forty percent patients showed PCR (66/165) after neoadjuvant immunochemotherapy. Nine Delta-RFs were selected as the most predictive factors for PCR. Logistic regression analysis showed that the Rad-score (OR = 8.542, 95% CI: 3.367-21.673, P<0.001) and ΔLMR (OR = 2.637, 95% CI: 1.094-6.359, P=0.031) were independent factors associated with PCR. With respect to predicting PCR, the Delta-RF model and the combined model both achieved satisfactory areas under the curve in the training (area under the curve [AUC]: 0.74, 0.788) and the validation was found to be cohort (AUC: 0.718, 0.737). The calibration curve showed that the predicted value of Delta-RF combined with haematological dynamic change model was in good agreement with the observed value. Decision curve analysis represented that the model exhibits high clinical practicability.

CONCLUSIONS

The Delta-RF model based on enhanced CT and the combined model can aid in efficient prediction of PCR after neoadjuvant immunochemotherapy in NSCLC, and the combined model can predict PCR performance better than Delta-RF model alone after neoadjuvant immunochemotherapy.

Integrating nutritional status and hematological biomarkers for enhanced prognosis prediction in glioma patients: A systematic review

PURPOSE

Multiple inflammatory and nutritional biomarkers have been established as independent prognostic factors across various solid tumors, but their role in outcomes prediction for glioma is still under investigation. Aim of the present systematic review is to report the available evidence regarding the impact of nutritional assessment and intervention for glioma prognosis and patients' quality of life (QoL).

MATERIALS AND METHODS

Our systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed and EMBASE databases were searched to identify studies assessing the impact of nutritional status and intervention and hematological biomarkers on survival outcomes and quality of life in patients with newly diagnosed gliomas. In the search strategy Medical Subject Headings (MeSH) terms were used. Search terms included ("nutritional status" or "nutritional assessment" or "nutritional intervention") AND ("glioma" or "glioblastoma" or "high-grade glioma" or "low-grade glioma" or "anaplastic astrocytoma" or "anaplastic oligodendroglioma") AND ("prognosis" or "survival outcomes"). The quality of each study was investigated based on the Newcastle-Ottawa Scale (NOS) criteria. Selected papers were in English and included publications in humans. This study was registered on PROSPERO (Registration No. CRD42024555442).

RESULTS

Our search retrieved 20 papers published between 2015 and 2023, all aiming at investigating correlations between hematological biomarkers (albumin, prealbumin, fibrinogen) and/or nutritional tools (Controlling Nutritional Score, CONUT; Prognostic Nutritional Index, PNI) and survival outcomes and quality of life of glioma patients. Nutritional intervention as well was evaluated for outcomes prediction. Overall, most papers contributed to the evidence of how nutritional assessment and inflammatory biomarkers could play an independent prognostic role also in the management of glioma patients.

CONCLUSIONS

PNI, CONUT score and hematological biomarkers (e.g. albumin, globulin, neutrophils, lymphocytes) may serve as useful predictors in patients with gliomas, potentially influencing clinical decisions. Additional large-scale studies are required to validate these findings and determine the mechanisms by which nutritional status, systemic inflammation and immune status affect prognosis in glioma patients.

Baseline Inflammatory Burden Index Predicts Primary Resistance to Combinations of ICIs With Chemotherapy in Patients With HER-2-Negative Advanced Gastric Cancer

PURPOSE

Combinations of immune checkpoint inhibitors (ICIs) and chemotherapy have become the standard first-line treatment for human epidermal growth factor receptor 2 (HER-2)-negative advanced gastric cancer. However, primary resistance remains a challenge, with no effective biomarkers available for its prediction. This retrospective study explores the relationship between the baseline inflammatory burden index (IBI) and primary resistance in such context.

MATERIALS AND METHODS

We analyzed 62 patients with HER-2-negative advanced gastric cancer who received ICIs and chemotherapy as their first-line treatment. The IBI was calculated as follows: C-reactive protein (mg/L) × neutrophil count (10³/mm³)/lymphocyte count (10³/mm³). Based on disease progression within 6 months, patients were categorized into the primary resistant or the control group. We compared baseline characteristics and IBI scores between the groups and assessed the predictive value of the IBI using the receiver operating characteristic curve. Both univariate and multivariate binary logistic regression analyses were conducted to identify factors influencing primary resistance.

RESULTS

Nineteen patients were included in the primary resistance group, and forty-three patients were included in the control group. The IBI was significantly higher in the resistant group compared to the control group (P<0.01). The area under the curve for the IBI was 0.82, indicating a strong predictive value. Multivariate analysis identified the IBI as an independent predictor of primary resistance (P=0.014).

CONCLUSIONS

The baseline IBI holds promise as a predictor of primary resistance to combined ICIs and chemotherapy in patients with HER-2-negative advanced gastric cancer.

Prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in second-line immunotherapy for patients with non-small cell lung cancer

Background

Immune checkpoint inhibitors remain a therapeutic option for chemotherapy pretreated patients with advanced non-small cell lung cancer (NSCLC). Given the lack of biomarkers, there is a need to look for predictive factors in this population. Inflammatory markers derived from peripheral blood cells (PBCs) may be a valuable diagnostic tool to assess the likelihood of clinical benefit. The aim of the study was to evaluate the efficacy of the treatment and to analyse the NLR and PLR predictive values.

Methods

Patients eligible for nivolumab or atezolizumab treatment in routine practice in two cancer centres between 2018 and 2021 were retrospectively analysed. Good performance status (ECOG 0-1), absence of EGFR, ALK, ROS1 alterations and no previous immune checkpoint inhibitors treatment were the inclusion criteria. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated based on the results obtained before the start of immunotherapy. The median value was used as the cut-off point for comparative analyses.

Results

The group of 332 patients was enrolled, 73.5% patients were in stage IV. The median NLR in the study group was 3.86±4.9 and the median PLR was 193.24±172.87. In the entire study group the disease control rate was 59 %, median PFS was 3.3 months [95% confidence interval (CI): 3.77 to 4.4], while median OS 11.57 months (95% CI: 9.03 to 12.73). In a univariate analysis the baseline values of NLR and PLR had a significant impact on survival, while age, gender, programmed death ligand 1 (PD-L1) expression, or type of treatment were not significant. In the multivariate Cox logistic regression model, a high value of NLR was the only factor that increased the risk of death [hazard ratio (HR) =1.6315, 95% CI: 1.2836 to 2.0737, P<0.001].

Conclusions

Inflammatory indices derived from peripheral blood cells-NLR and PLR-can help assess the prognosis of patients receiving immunotherapy. They also appear to be independent prognostic factors with regard to for PFS and OS.

Neutrophil-to-Lymphocyte Ratio as a Potential Predictive Marker for Epileptic Seizures: Unveiling the "V"-Shaped Link

Objective: The neutrophil-to-lymphocyte ratio (NLR) is an important marker of inflammation. An increased NLR has been detected in the blood of patients with epilepsy. However, the correlation between varying NLRs and epileptic seizures (ESs) is still unclear. Methods: A retrospective analysis was conducted, and patients were divided into two groups based on whether they had ES upon admission. Comprehensive data were collected, including routine blood tests, demographic information, and medical histories. The NLR was calculated by dividing the percentage of neutrophils by the percentage of lymphocytes. Results: In total, 414 patients were included (284 males, 151 females; aged 18-90 years), with 271 in the experimental group and 143 in the control group. No significant differences in the NLR were found between the groups (p=0.164). Nonetheless, when NLRs were categorized, a "V"-shaped link with ES was observed. An NLR of 2-3 correlated with the lowest seizure incidence. Higher NLRs were associated with increased neutrophil and decreased lymphocyte counts. Patients with an NLR < 2 had the lowest infection rates and the highest cerebrovascular disease exposure, whereas those with an NLR > 3 had the highest infection rates and were the oldest. Conclusions: NLR modifications can serve as potential predictive markers for ES. However, the relationship between the NLR and ES is not linear. The factors contributing to these variations are multiple and complex. An NLR of 2-3 may represent an equilibrium point. An elevated NLR indicates pronounced inflammatory responses, while a low NLR can have more complex causes.

Trends in hemoglobin-to- red cell distribution width ratio and its prognostic value for all-cause, cancer, and cardiovascular mortality: a nationwide cohort study

The hemoglobin-to-red blood cell distribution width ratio (HRR) has emerged as a potential predictor of various health outcomes. This study aimed to investigate the association between HRR and all-cause, cancer, and cardiovascular mortality. This cohort study used data from 28,825 participants in the 1999-2018 U.S. National Health and Nutrition Examination Survey. Weighted Cox regression was used to assess the associations between HRR and mortality. Restricted cubic spline (RCS) models evaluated the non-linear associations between HRR and mortality risk. Subgroup and sensitivity analyses were conducted to assess the robustness of the study results. Trend tests assessed the temporal trends of mean HRR. Lower HRR was significantly linked to increased risks of all-cause, cancer, and cardiovascular mortality. According to the fully adjusted model, the highest quintile of HRR (Q5) showed lower mortality risks compared to the lowest quintile (Q1): all-cause mortality (HR 0.47, 95% CI 0.40, 0.55), cancer mortality (HR 0.51, 95% CI 0.37, 0.71), and cardiovascular mortality (HR 0.43, 95% CI 0.32, 0.56). A significant trend effect was observed across HRR quintiles (P for trend < 0.0001). Nonlinear association analyses suggested a linear relationship between HRR and cardiovascular mortality, while "L"-shaped associations were observed for all-cause and cancer mortality. Notably, the mean HRR levels decreased from 1.18 (95% CI 1.16-1.19) in 1999-2000 to 1.07 (95% CI 1.05-1.08) in 2017-2018. An inverse association between HRR and mortality risk was found, with lower HRR levels indicating higher mortality risk. Over the past two decades (1999-2018), there has been a significant decline in HRR levels among U.S. adults. HRR may serve as a valuable and easily obtainable predictor for mortality risk assessment in clinical practice.

Perioperative inflammatory index differences between pulmonary squamous cell carcinoma and adenocarcinoma and their prognostic implications

Background

Perioperative inflammatory indices reflect systemic inflammatory responses and have been linked to cancer progression and prognosis. This study aims to explore the differences in perioperative inflammatory indices between lung squamous cell carcinoma (LSCC) and adenocarcinoma (LUAD) and their association with long-term outcomes.

Methods

This study included 287 lung cancer patients who underwent curative resection between June 2016 and December 2017, comprising 61 cases of LSCC and 226 cases of LUAD. Perioperative baseline information and inflammatory cell counts were collected. Patients were followed up for a median duration of 76 months, during which disease-free survival (DFS) and overall survival (OS) were recorded. Cox regression analysis was used to evaluate the prognostic significance of inflammatory factor levels.

Results

Significant differences were observed in white blood cell count and systemic inflammation response index (SIRI) between LSCC and LUAD (P < 0.05). Regression analysis identified age (OR=2.096, P=0.004), postoperative day 1 D-dimer level (OR=1.550, P<0.001), and Platelet-to-lymphocyte ratio (PLR) (OR=1.901, P=0.031) as independent risk factors for perioperative venous thromboembolism (VTE). Furthermore, open surgical approach (HR=2.437, P=0.016), tumor type (LSCC; HR=2.437, P=0.016), and PLR (HR=1.534, P=0.019) were independent risk factors for DFS.

Conclusion

Inflammatory index is key predictors of perioperative VTE and DFS in lung cancer, emphasizing their critical role in prognosis.

Detecting the preoperative peripheral blood systemic immune-inflammation index (SII) as a tool for early diagnosis and prognosis of gallbladder cancer

OBJECTIVE

Evidence indicates that the systemic immune-inflammation index (SII) correlates with poor prognosis in various solid tumors. This retrospective study aimed to evaluate the diagnostic and prognostic significance of preoperative SII combined with tumor markers for early detection and prognosis of gallbladder cancer (GBC).

METHODS

Preoperative SII levels and serum tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), and carbohydrate antigen 19 - 9 (CA19-9)] were measured in GBC patients. Correlations and diagnostic efficacy were analyzed using Spearman correlation and receiver operating characteristic (ROC) curve analyses. The relationship between SII and clinical data was analyzed, and cumulative survival rates of the two groups were compared. Independent risk factors for poor prognosis in GBC patients were assessed using Kaplan-Meier curves and Cox multivariate analysis.

RESULTS

Preoperative SII, CEA, CA125, and CA19-9 levels were significantly elevated in GBC patients compared to those with benign lesions. SII positively correlated with CEA, CA125, and CA19-9 levels (r = 0.434, 0.570, 0.614, respectively, all P < 0.001). The area under the ROC curve (AUC) for the combination of SII, CEA, CA125, and CA19-9 was 0.877 for early GBC diagnosis and 0.923 for predicting postoperative mortality, outperforming each marker individually. An SII threshold > 889.52 was predictive of postoperative death. High SII was associated with tumor size, differentiation, tumor-node-metastasis stage, lymph node metastasis, perineural invasion, surgical type, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and serum tumor marker levels. Kaplan-Meier analysis revealed poorer survival in the high SII group. Preoperative SII was identified as an IRF for poor prognosis in GBC patients.

CONCLUSION

Preoperative SII correlates strongly with CEA, CA125, and CA19-9 levels. The combined use of SII and tumor markers offers high diagnostic value for early GBC detection and robust predictive value for postoperative mortality. Preoperative SII serves as an IRF for poor prognosis in GBC patients.

A Nomogram Based on Circulating Inflammatory Factors for Predicting Prognosis of Newly Diagnosed Multiple Myeloma Patients

Purpose

The growth and survival of multiple myeloma (MM) cells depend heavily on bone marrow microenvironment, where inflammation emerges as a significant feature and is commonly associated with unfavorable prognosis in MM. Our previous study and other published studies have shown that MM patients with higher neutrophil-to-lymphocyte ratio (NLR) or interleukin (IL)-10 (IL-10), lower lymphocyte-to-monocyte ratio (LMR) or platelet-to-lymphocyte ratio (PLR) frequently have inferior overall survival (OS) independent of current risk- stratification markers. Nevertheless, whether specific inflammation-related markers have prognostic value for MM patients remains elusive.

Patients and methods

We retrospectively analyzed the clinical data of 452 newly diagnosed MM (NDMM) patients treated in our center from May 2013 to June 2022. Cox regression analysis and least absolute shrinkage and selector operation (LASSO) were performed to establish the predictive nomograms for survival outcomes in the training cohort, and the nomograms were validated by calibration curves in the validation cohort.

Results

The best cutoff values of NLR, LMR, PLR, and IL-10 were 4.44, 4.0, 100, and 1.42pg/mL, respectively. We established a nomogram model after LASSO Cox and multivariate Cox regression analysis. The nomogram model exhibited acceptable discrimination, with C-index values of 0.777, 0.714, and 0.71 in the training cohort, validation cohort, and entire cohort, respectively, which was significantly higher than the C-indices of the three most extensively used staging systems for NDMM (D-S, ISS, and R-ISS). All calibration curves revealed good consistency between the predictive and actual survival outcomes. Patients were divided into high-risk and low-risk groups based on their total nomogram scores, with a threshold of 106.2, where the median OS of patients in the high-risk group was significantly shorter than that of patients in the low-risk group.

Conclusion

The proposed nomogram based on circulating inflammatory factors is an inexpensive, widely available, and easily interpretable risk-stratification tool for NDMM patients.

The association of systemic immune-inflammation index with incident breast cancer and all-cause mortality: evidence from a large population-based study

BACKGROUND

Chronic low-grade inflammation is recognized as a significant factor in various health outcomes, including the development and progression of breast cancer. The Systemic Immune-Inflammation Index (SII), a novel marker derived from routine blood counts, has been suggested as a predictor of all-cause mortality and cardiovascular mortality. However, its predictive value in a nationwide representative population, particularly for breast cancer incidence and mortality, is not well-established.

METHODS

This study aimed to assess the association of SII and the risk of breast cancer incidence and all-cause mortality in breast cancer patients within the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. SII was calculated from complete blood count parameters. We used multifactor regression models to examine the associations between SII and the outcomes of interest.

RESULTS

A total of 21,058 female participants were included in the study, of which 557 (2.7%) were identified as having breast cancer. After adjusting for multiple potential confounders, the relationship between SII and the incidence of breast cancer revealed an inverse L-shaped association. The optimal inflection point for SII/100 was determined to be 5.09. Below this threshold, there was a significant increase in the risk of breast cancer (OR=1.05, 95% CI: 1.02-1.09). Within the breast cancer population, SII exhibited a J-shaped relationship with all-cause mortality. The optimal inflection point for SII/100 in this context was 5.22, and above this threshold, there was a marked escalation in all-cause mortality (HR=1.09, 95% CI: 1.04-1.14).

CONCLUSION

The SII, as a novel inflammatory composite index, is significantly associated with the risk of breast cancer incidence and all-cause mortality in breast cancer patients. These findings highlight the importance of monitoring systemic inflammation and suggest that SII could serve as a valuable prognostic tool.

Triple-negative breast cancer modifies the systemic immune landscape and alters neutrophil functionality

Cancer disrupts intratumoral innate-adaptive immune crosstalk, but how the systemic immune landscape evolves during breast cancer progression remains unclear. We profiled circulating immune cells in stage I-III and stage IV triple-negative breast cancer (TNBC) patients and healthy donors (HDs). Metastatic TNBC (mTNBC) patients had reduced T cells, dendritic cells, and differentiated B cells compared to non-metastatic TNBC patients and HDs, partly linked to prior chemotherapy. Vδ1 γδ T cells from mTNBC patients produced more IL17 than those from HDs. Chemotherapy-naïve mTNBC patients showed increased classical monocytes and neutrophils. Transcriptional, proteomic, and functional analyses revealed that neutrophils in mTNBC exhibited enhanced migratory capacity, elevated granule proteins, and higher ROS production. Some immune changes, such as reduced non-switched B cells and heightened neutrophil migration, were evident in earlier TNBC stages. This study comprehensively maps systemic immunity in TNBC, guiding future research on patient stratification and immunomodulation strategies.

Prognostic value of systemic immune-inflammation index in patients with small-cell lung cancer treated with immune checkpoint inhibitors

INTRODUCTION

The systemic immune-inflammation index (SII) has emerged as a promising prognostic marker in various malignancies. However, its prognostic significance in patients with small-cell lung cancer (SCLC) treated with immune checkpoint inhibitors (ICIs) remains unclear. In this study, we evaluated the prognostic impact of the SII in patients with SCLC after ICI use.

METHODS

Of 62 patients with SCLC who received chemoimmunotherapy at our institution between September 2019 and July 2024, we retrospectively analyzed 36 patients who subsequently received ICI maintenance therapy following the initial chemoimmunotherapy treatment. The SII was calculated at the start of the second cycle of the ICI maintenance therapy. Patients were stratified into high (≥ 570) and low (< 570) SII groups. Overall survival (OS) and progression-free survival (PFS) were compared between the groups using the Kaplan-Meier method and log-rank test. Multivariate analysis using the Cox proportional hazards model was performed to identify independent prognostic factors.

RESULTS

The high SII group exhibited a significantly shorter OS (median 12.1 vs. 24.1 months, P = 0.010) and PFS (median 5.2 vs. 8.1 months, P = 0.026) than those in the low SII group. A multivariate analysis identified SII ≥ 570 as an independent negative prognostic factor for OS (hazard ratio 3.83, 95% confidence interval 1.38-10.6, P = 0.010).

CONCLUSIONS

Elevated SII in the initial phase of ICI maintenance therapy was associated a with poor prognosis in patients with SCLC, supporting its utility as a prognostic biomarker in this setting. Therefore, prospective validation is required to confirm these findings.

Pretreatment neutrophil-to-lymphocyte ratio is associated with immunotherapy efficacy in patients with advanced cancer: a systematic review and meta-analysis

This study aimed to systematically investigate the value of the pre-treatment neutrophil-to-lymphocyte ratio (NLR) in prognosticating the outcome of patients with advanced cancer receiving immunotherapy. We searched Embase, PubMed, Web of Science, and Cochrane Library to identify studies about cancer patients with immunotherapy until November 29, 2024. Retrospective or prospective cohort studies with pretreatment NLR data were included. The odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the predictive value of NLR in prognosis and immunotherapy efficacy. The random effect model was applied for meta-analysis and the risk of bias was assessed by Egger test and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. A total of 129 articles involving 18780 cases were finally selected. Most cases were advanced cancers with the median follow-up period ranged 2-48.6 months. The high pretreatment NLR level was associated with the significantly reduced OS (HR (95%CI) = 2.26 (2.03, 2.53)), PFS (HR (95% CI) = 1.83 (1.69, 1.98)), ORR (OR (95%CI) = 0.53 (0.46, 0.61)) and DCR (OR (95% CI) = 0.36 (0.29, 0.43)) in patients with advanced cancer receiving immunotherapy. The quality of evidence was low, attributed to the serious risk of bias and incon¬sistency. An elevated NLR before immunotherapy was significantly associated with poor clinical outcomes in patients with advanced cancer.

Predicting response to PD-1 inhibitors in head and neck squamous cell carcinomas using peripheral blood inflammatory markers

Immune checkpoint inhibitor (ICI) treatment has the potential to induce durable disease remission. However, the current combined positive score (CPS) is insufficient accurate for predicting which patients will benefit from it. In the present study, a real-world retrospective study was conducted on 56 patients of HNSCC who received ICI treatment. Then the treatment that patient received and levels of pre-treatment blood inflammatory markers (NLR, MLR and PLR) were identified to develop a model for predicting immunotherapy response. Notably, the model achieved an area under the curve (AUC) of 0.877 (95 % CI 0.769-0.985) , providing a larger net benefit than the CPS marker (AUC=0.614, 95 % CI 0.466-0.762). Furthermore, the internal validation of the prediction model showed a C-index of 0.835. Patients with high score of the model would get improved PFS than those with low score. Therefore, the prediction model for patients with local advanced or R/M HNSCC receiving ICI treatment, which represented an better efficient prediction of immunotherapy response than CPS marker.

Prognostic nutrition index as a predictive factor for overall survival in trabectedin-treated advanced soft tissue sarcoma

BACKGROUND

Trabectedin binds covalently to the DNA minor groove and causes DNA to bend toward the main groove, then trabectedin regulates the transcription of the involved genes in cell proliferation or acts on the mononuclear phagocyte system in tumors, which contributes to its antitumor effects. Several clinical trials confirmed the efficacy of trabectedin for patients with advanced soft tissue sarcoma (STS) although clinically useful biomarkers remained unidentified. This study aimed to identify prognostic factors of trabectedin treatment, especially focusing on the systemic inflammatory, immune response, and nutritional status.

METHODS

This study included 44 patients with advanced STS treated with trabectedin from January 2018 to August 2022. We evaluated the associations of clinical factors that influence the efficacy of trabectedin treatment with progression-free survival (PFS) and overall survival (OS), focusing on systemic inflammatory, immune response, and nutritional status represented by the absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), prognostic nutrition index (PNI), and C-reactive protein (CRP) using the Kaplan-Meier method and the log-rank test.

RESULTS

ALC, LMR, PNI, NLR, PLR, and SIRI demonstrated no association with PFS. Patients with CRP of ≥0.3 had a significantly shorter PFS than those with CRP of <0.3 (median PFS: 863 vs. 105 days, P = 0.045). PNI of ≥44 (median: 757 days vs. 232 days, P = 0.021) and CRP of <0.3 (median: 877 days vs. 297 days, P = 0.043) were significantly good prognostic factors in terms of OS.

CONCLUSIONS

The study results indicate pretreatment PNI and CRP levels as prognostic factors for trabectedin treatment in advanced STS.

Systemic immune-inflammatory index predict short-term outcome in recurrent/metastatic and locally advanced cervical cancer patients treated with PD-1 inhibitor

This study aims to assess the predictive value of certain markers of inflammation in patients with locally advanced or recurrent/metastatic cervical cancer who are undergoing treatment with anti-programmed death 1 (PD-1) therapy. A total of 105 patients with cervical cancer, who received treatment involving immunocheckpoint inhibitors (ICIs), were included in this retrospective study. We collected information on various peripheral blood indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI). To determine the appropriate cutoff values for these inflammatory markers, we performed receiver operating characteristic curve (ROC) analysis. Progression-free survival (PFS) was estimated using the Kaplan-Meier method, and we conducted both univariate and multivariate Cox regression analyses to evaluate the prognostic value of these markers. Out of the 105 patients who received ICI treatment, the median progression-free survival (mPFS) was 19.0 months. We obtained the patients' clinical characteristics, such as age, pathological type, therapy regimen, Figo stage, NLR, PLR, LMR, SII, and PNI from their medical records. The optimal cutoff values for NLR, PLR, LMR, SII, and PNI were determined as 3.76, 218.1, 3.34, 1147.7, 43.75, respectively. In the univariate analysis, age, pathological type, therapy regimen, Figo stage, and LMR were not found to be associated with PFS. However, high NLR(P=0.001), high PLR(P<0.001), high SII(P<0.001), and low PNI (P=0.003)were all associated with shorter PFS. Multivariate analysis indicated that SII (P=0.017) was an independent risk factor for PFS. This study highlights the potential use of SII as a predictor of progression-free survival in cervical cancer patients undergoing immunotherapy.

Effects of intravenous anesthesia and inhalation anesthesia on postoperative inflammatory markers in patients with esophageal cancer: a retrospective study

BACKGROUND

Inflammatory markers have been confirmed to be associated with the prognosis of cancer patients. In this study, we compared the impacts of intravenous anesthesia and inhalation anesthesia on the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) after esophageal cancer surgery.

METHODS

We retrospectively reviewed the electronic medical records of patients who underwent esophagectomy from January 1, 2014 to December 31, 2016. Patients respectively received total intravenous anesthesia (TIVA) or inhalational anesthesia (INHA). Inverse probability of treatment weighting (IPTW) was employed to minimize differences. The Mann-Whitney U test or Kruskal Wallis test was utilized to compare the effect of the two groups on postoperative NLR, PLR and SII.

RESULTS

A total of 519 patients who had undergone esophageal cancer resection were recruited in this study, among whom 339 patients were eligible (TIVA group, n = 201, INHA group, n = 138). After IPTW, there was no statistically significant difference in NLR, PLR, and SII on the first postoperative day(P = 0.1951), (P = 0.5611), (P = 0.9684) and on the third postoperative day(P = 0.5961), (P = 0.1804), (P = 0.9653) between the two groups.

CONCLUSIONS

In conclusion, there was no significant difference in NLR, PLR and SII between intravenous anesthesia or inhalational anesthesia. TIVA is not superior to INHA in reducing the perioperative inflammatory response of esophageal cancer.

SYNOPSIS

Inflammatory markers play an important role in the recurrence, metastasis and survival of tumor patients after surgery. In this study, we will compare the effects of different anesthesia methods on inflammatory markers.

Combining serum inflammatory markers and clinical factors to predict survival in metastatic urothelial carcinoma patients treated with immune checkpoint inhibitors

Background

Despite the revolutionary impact of immune checkpoint inhibitors (ICIs) on the treatment of metastatic urothelial carcinoma (mUC), the clinical utility of reliable prognostic biomarkers to foresee survival outcomes remains underexplored.

Objectives

The purpose of this study was to ascertain the prognostic significance of serum inflammatory markers in mUC patients undergoing ICI therapy.

Design

This is a retrospective, multicenter study.

Methods

Data were collected from two independent medical centers in Taiwan, encompassing a validation and a training cohort (TC). Patients with histopathologically confirmed urothelial carcinoma who received at least one cycle of ICI monotherapy were included. Serum inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated prior to ICI therapy. Statistical analyses involved the use of receiver operating characteristic (ROC) curves to determine optimal biomarker cutoffs and Cox proportional hazards models to evaluate the independent predictive capability of these markers.

Results

A total of 192 patients were enrolled. In the univariate analysis, serum markers such as NLR, PLR, SII, and Hb were significantly associated with overall survival (OS) in both the training and validation cohorts (VC). White blood cells, NLR, and SII demonstrated a robust correlation with progression-free survival across both cohorts. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status ⩾2 (p < 0.001), visceral metastasis (p < 0.001), leukocytosis (p < 0.001), Hb levels ⩾10 mg/dL (p = 0.008), and NLR ⩾5 (p = 0.032) as independent predictors of OS. A prognostic nomogram integrating these independent factors yielded a C-index for a 3-year OS of 0.769 in the TC and 0.657 in the VC.

Conclusion

Serum inflammatory markers, combined with clinicopathologic factors, provide a practical prognostic tool in mUC treatment with ICIs.

Comparative Assessment of the qSOFA, SII, dNLR, and OISS Infection Severity Scores in Diabetic Versus Non-Diabetic Patients with Odontogenic Infections

Background and Objectives: Odontogenic infections (OIs) can progress rapidly and may lead to severe systemic complications, especially in patients with underlying conditions like diabetes mellitus (DM). This study aims to evaluate the predictive value of inflammatory scores-quick Sequential Organ Failure Assessment (qSOFA), Systemic Immune-Inflammation Index (SII), derived Neutrophil-to-Lymphocyte Ratio (dNLR), and Odontogenic Infection Severity Score (OISS)-in assessing the severity of OIs in diabetic versus non-diabetic patients. Materials and Methods: A case-control study was conducted on 123 patients diagnosed with OIs. Patients were divided into two groups: patients with diabetes (n = 42) and patients who were non-diabetic (n = 81). Inflammatory scores were calculated at admission and correlated with clinical outcomes. Statistical analyses included t-tests, chi-square tests, and multivariate logistic regression. Results: The patients with diabetes exhibited significantly higher OISS scores (mean 6.5 ± 2.8) compared to the patients who were non-diabetic (mean 4.8 ± 2.1, p < 0.001). The inflammatory markers qSOFA, SII, and dNLR were significantly elevated in the diabetic group (all p < 0.01). The SII demonstrated the highest predictive accuracy for severe OIs in patients with diabetes, with an area under the curve (AUC) of 0.88 (95% CI: 0.80-0.95). Diabetes mellitus was an independent predictor of severe OIs (OR: 3.2, 95% CI: 1.5-6.8, p = 0.003). Conclusions: Inflammatory scores, particularly SII, are effective in predicting the severity of odontogenic infections in patients with diabetes. Incorporating these scores into clinical practice may enhance the early identification of high-risk patients and improve management strategies.

Ex vivo assessment of human neutrophil motility and migration

Neutrophils are pivotal in orchestrating tumor-induced systemic inflammation and are increasingly recognized for their critical involvement in both the initiation and progression of cancer. A fundamental facet of neutrophil biology is their migratory capacity, which enables them to extravasate and infiltrate tumors in other tissues, where they carry out essential effector functions. Unraveling the intricate mechanisms of neutrophil motility and migration is crucial for comprehending immune responses and inflammatory processes, shedding light on their substantial contribution to cancer progression. Here, we provide a comprehensive protocol to assess direct ex vivo motility and migration of freshly isolated human neutrophils, offering valuable insights into their behavior.

Correlation of hemoglobin, albumin, lymphocyte, and platelet score with prognosis in patients with stage III squamous lung cancer

Background

Among cancers, lung cancer has the second highest incidence rate and the highest mortality rate in the world. Identifying suitable biomarkers to assist in the prognostic prediction of lung cancer is crucial for developing individualized treatment plans. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been applied to predict patient prognosis across a variety of cancers. This study aimed to investigate the predictive value of the HALP score for the prognosis of patients with stage III squamous cell lung cancer.

Methods

The clinical data of patients with stage III squamous lung cancer who had undergone radical radiotherapy at the Department of Radiotherapy of The Fourth Hospital of Hebei Medical University from January 2011 to December 2020 were retrospectively analyzed. The optimal cutoff values for continuous variables were determined using X-Tile software. A Cox proportional hazards model was used for univariate and multivariate analysis, the Kaplan-Meier method was used for survival analysis, and log-rank test was used to check for differences.

Results

A total of 206 patients were included in this study, and the cutoff value for the HALP score was 24.3. There were statistically significant differences between the high- and low-HALP-score groups in terms of alcohol consumption history, tumor-node-metastasis (TNM) stage, prognostic nutritional index (PNI) score, and systemic immune-inflammation index (SII) score. The median overall survival (OS) was 11.0 and 22.0 months in the low- and high-HALP-score groups, respectively (P<0.001), and the median progression-free survival (PFS) was 8.0 and 13.0 months, respectively (P=0.002). Univariate analysis showed that a low HALP score was significantly associated with OS [hazard ratio (HR) =1.698, 95% confidence interval (CI): 1.261-2.286; P<0.001] and PFS (HR =1.584, 95% CI: 1.176-2.132; P=0.002) in patients with stage III lung squamous carcinoma, while the multivariate analysis showed that a low HALP score was the most important factor in OS (HR =1.538, 95% CI: 1.137-2.079; P=0.005) and PFS (HR =1.399, 95% CI: 1.033-1.895; P=0.03) as independent predictors of poor prognosis.

Conclusions

In patients with stage III squamous cell lung cancer treated with radical radiotherapy, low baseline HALP score is associated with its poorer OS and PFS and may thus be valuable prognostic factor.

Peripheral biomarkers to assess risk, severity, and prognosis of immune checkpoint inhibitor-associated myocarditis: a retrospective clinical study

Background

Immune checkpoint inhibitor-associated myocarditis (ICI myocarditis) is an infrequent but potentially fatal immune-related adverse event. This study aimed to identify valuable indicators for risk prediction and evaluation of disease severity and outcomes.

Methods

A total of 79 patients with severe or mild ICI myocarditis and 158 controls without post-ICI immune-related adverse events were enrolled in this retrospective study. The clinical application value of a series of simple biomarkers were tested.

Results

Higher levels of the systemic immune-inflammation index (SII), neutrophil-to-eosinophil ratio (NER), aspartate transferase-to-albumin ratio (AAR), and lactic dehydrogenase-to-albumin ratio (LAR) at myocarditis onset were associated with severe disease conditions. In the receiver operating characteristic analysis, biomarkers areas under the curve (AUC) close to or greater than 0.8 were LAR (AUC: 0.810) and AAR (AUC: 0.806). Patients with higher SII, AAR, and LAR also exhibited poorer overall survival. The SII, NER, AAR, and LAR before the last ICI treatment increased relative to baseline in patients with ICI myocarditis, whereas no significant changes in the tested biomarkers were observed in the control group. For SII, AAR, and LAR, high ratios of the biomarker levels before the last ICI to baseline was associated with the incidence of myocarditis.

Conclusions

Surveillance of these economical biomarkers during ICI therapy might contribute to the risk prediction of ICI myocarditis, as well as the assessment of disease severity and prognosis.

Predicting the prognosis of patients with renal cell carcinoma based on the systemic immune inflammation index and prognostic nutritional index

The aim of the study was to analyze and discuss the value of preoperative systemic immune inflammation index (SII) and prognostic nutritional index (PNI) in predicting the prognosis of patients with renal cell carcinoma (RCC) after operation, and to establish a nomogram prediction model for patients with RCC after operation based on SII and PNI. From January 2014 to December 2018, 210 patients with RCC who underwent surgical treatment at the Xuzhou Central Hospital were selected as the research object. The receiver operating characteristic curve (ROC) was used to determine the optimal cut-off value for preoperative SII, PNI, LMR, PLR, NLR and the patients were divided into groups according to the optimal cutoff values. The survival rate of patients was evaluated. The risk factors that affect the prognosis of patients with RCC were determined by LASSO and Cox regression analysis, and a prognostic nomogram was constructed based on this result. The bootstrap method was used for internal verification of the nomogram model. The prediction efficiency and discrimination of the nomogram model were evaluated by the calibration curve and index of concordance (C-index), respectively. The average overall survival (OS) of all patients was 75.385 months, and the 1-, 2-and 3-year survival rates were 95.5%, 86.6% and 77.2%, respectively. The survival curve showed that the 5-year OS rate of low SII group was significantly higher than that of high SII group (89.0% vs. 64.5%; P < 0.05), and low PNI group was significantly lower than those in high PNI group (43.4% vs. 87.9%; p < 0.05). There were significant differences between preoperative SII and CRP, NLR, PLR, LMR, postoperative recurrence, pathological type and AJCC stage (P < 0.05). There were significant differences between preoperative PNI and BMI, platelet, NLR, PLR, LMR, postoperative recurrence, surgical mode and Fuhrman grade (P < 0.05). The ROC curve analysis showed that the AUC of PNI (AUC = 0.736) was higher than that of other inflammatory indicators, followed by the AUC of SII (0.718), and the difference in AUC area between groups was statistically significant (P < 0.05). The results from multivariate Cox regression analysis showed that SII, PNI, tumor size, tumor necrosis, surgical mode, pathological type, CRP, AJCC stage and Fuhrman grade were independent risk factors for postoperative death of patients with RCC. According to the results of Cox regression analysis, a prediction model for the prognosis of RCC patients was established, and the C-index (0.918) showed that the model had good calibration and discrimination. The subject's operating characteristic curve indicates that the nomogram has good prediction efficiency (the AUC = 0.953). Preoperative SII and PNI, tumor size, tumor necrosis, surgical mode, pathological type, CRP, AJCC stage and Fuhrman grade are closely related to the postoperative prognosis of patients with renal cell carcinoma. The nomogram model based on SII, PNI, tumor size, tumor necrosis, surgical mode, pathological type, CRP, AJCC stage and Fuhrman grade has good accuracy, discrimination and clinical prediction efficiency.

Gender differences in postoperative pain, sleep quality, and recovery outcomes in patients undergoing visual thoracoscopic surgery

Objective

The purpose of our study was to investigate the effect of gender on postoperative pain, sleep quality, and recovery outcomes in patients undergoing VATS surgery under general anesthesia.

Method

Perioperative peripheral blood inflammatory markers system inflammation Index (SII) was recorded for perioperative inflammatory response. The visual analog scale (VAS) was used to evaluate pain level. And the Athens Insomnia Scale (AIS) was evaluated on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3) for postoperative sleep.

Result

In this prospective cohort study, 79 males and 79 females were consecutively included. Females had significantly higher pain score (both rest and cough pain) compared to the males at 3 h after the surgery (3.85 ± 1.2 vs. 3.16 ± 1.1) (rest) (p < 0.001) and 5.10 ± 1.3 vs. 4.46 ± 1.6 (coughing) (p = 0.006)). Patients in the male group had significantly lower AIS scores than those in the female group at Sleep POD 1 and Sleep POD 3 (p = 0.024 and p = 0.045). And in both groups, postoperative SII was increased and statistically significant compared to preoperative SII (p < 0.001, respectively). Women presented higher levels of SII on the first day after surgery, and the increase of postoperative SII in females groups was significantly higher than that in male group when compared to preoperative SII (1806.33 ± 1314.8 vs 1430.55 ± 958.4) (p = 0.042).

Conclusion

These findings highlight the complex multidimensional nature of postoperative pain, nausea and vomiting, sleep quality and the potential contributory role of sex in shaping these outcomes. Women had worse sleep quality, higher postoperative inflammatory response level and pain level than men.

Risk factor analysis and predictive model construction for bone metastasis in newly diagnosed malignant tumor patients

OBJECTIVE

To identify risk factors for bone metastasis in patients with newly diagnosed malignant tumor and to develop a prediction model.

METHODS

Clinical data from 232 patients with newly diagnosed malignant tumors were analyzed to screen for risk factors associated with bone metastasis. A nomogram prediction model was constructed using R software. The model's performance was evaluated using Receiver Operating Characteristic (ROC) analysis, Bootstrap sampling, and Decision Curve Analysis (DCA).

RESULTS

The incidence of bone metastasis in the 232 cases with newly diagnosed malignant tumors was 21.98% (51/232). Multivariate logistic regression analysis revealed that tumor staging III-IV, lymph node metastasis, high Eastern Cancer Collaboration Group Physical Status (ECOG-PS) score, high alkaline phosphatase (ALP) expression, and high SII index were risk factors for bone metastasis at initial diagnosis (all P<0.05). The area under the curve (AUC) of the nomogram model was 0.893. Bootstrap sampling validation showed a small error of 0.017 between predicted and actual probabilities. DCA supported the utility of the model in clinical practice.

CONCLUSION

Bone metastasis in newly diagnosed malignant tumors is associated with advanced tumor staging, lymph node metastasis, high ECOG-PS score, elevated ALP expression, and a high SII index. A nomogram model based on these factors can effectively predict the risk of bone metastasis in these patients.

Unveiling inflammatory biomarkers in multibacillary leprosy: the role of lymphocyte-platelet ratio in predicting leprosy reactions

Leprosy is a neglected contagious disease that causes physical disability and episodes of inflammation, called leprosy reactions. There are currently no consolidated laboratory markers that can predict or confirm the diagnosis of leprosy reactions, negatively impacting the progression of the disease. The aim of this study was to analyze the behavior of inflammatory biomarkers in a population of patients with multibacillary leprosy. This prospective study in a northeastern capital involved 67 new cases of multibacillary leprosy, assessing inflammatory biomarkers at diagnosis. Histopathology, qPCR, slit skin smear microscopy, and laboratory tests, including CRP-albumin, neutrophil-lymphocyte, lymphocyte-monocyte, platelet-lymphocyte ratios, and systemic immune-inflammation index, were conducted. Statistical analysis utilized Stata version 16.0®, employing Chi-square, Kruskal-Wallis, and Poisson regression (5% significance). The population, mainly young brown men with low socioeconomic status, borderline leprosy, and and degree of physical disability one, saw 19.4% experiencing leprosy reactions. Standard multibacillary multidrug therapy was administered to all. Ratios and index values exceeding medians were prevalent (46.3-47.8%). Assessing biological markers against leprosy reactions revealed a positive relation between reactions and lymphocyte-platelet ratio (p = 0.05) and a positive trend with the systemic immune-inflammation index (p = 0.06). Patients with reactions were 1.3 times more likely to exhibit an elevated lymphocyte-platelet ratio. The lymphocyte-platelet ratio emerged as a potential indicator for recognizing leprosy reactions. Further research is essential to validate these findings, aiming for earlier detection of leprosy reactions.

Development and validation of a nomogram for predicting mortality in patients with acute severe traumatic brain injury: A retrospective analysis

BACKGROUND

Recent evidence links the prognosis of traumatic brain injury (TBI) to various factors, including baseline clinical characteristics, TBI specifics, and neuroimaging outcomes. This study focuses on identifying risk factors for short-term survival in severe traumatic brain injury (sTBI) cases and developing a prognostic model.

METHODS

Analyzing 430 acute sTBI patients from January 2018 to December 2023 at the 904th Hospital's Neurosurgery Department, this retrospective case-control study separated patients into survival outcomes: 288 deceased and 142 survivors. It evaluated baseline, clinical, hematological, and radiological data to identify risk and protective factors through univariate and Lasso regression. A multivariate model was then formulated to pinpoint independent prognostic factors, assessing their relationships via Spearman's correlation. The model's accuracy was gauged using the Receiver Operating Characteristic (ROC) curve, with additional statistical analyses for quantitative factors and model effectiveness. Internal validation employed ROC, calibration curves, Decision Curve Analysis (DCA), and Clinical Impact Curves (CIC) to assess model discrimination, utility, and accuracy. The International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) and Corticosteroid Randomization After Significant Head injury (CRASH) models were also compared through multivariate regression.

RESULTS

Factors like unilateral and bilateral pupillary non-reactivity at admission, the derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR), D-dimer to fibrinogen ratio (DFR), infratentorial hematoma, and Helsinki CT score were identified as independent risk factors (OR > 1), whereas serum albumin emerged as a protective factor (OR < 1). The model showed superior predictive performance with an AUC of 0.955 and surpassed both IMPACT and CRASH models in predictive accuracy. Internal validation confirmed the model's high discriminative capability, clinical relevance, and effectiveness.

CONCLUSIONS

Short-term survival in sTBI is significantly influenced by factors such as pupillary response, dNLR, PLR, DFR, serum albumin levels, infratentorial hematoma occurrence, and Helsinki CT scores at admission. The developed nomogram accurately predicts sTBI outcomes, offering significant clinical utility.

Association Between Systemic Immune-Inflammation Index and Psoriasis, Psoriasis Comorbidities, and All-Cause Mortality: A Study Based on NHANES

OBJECTIVE

The relationship between systemic immune-inflammation index (SII) and psoriasis and its prognosis is not yet clear. In this study, the correlation between SII and psoriasis, psoriasis comorbidities, and all-cause mortality was investigated based on the National Health and Nutrition Examination Survey (NHANES).

METHODS

The study population was derived from five NHANES cycles: 2003-2006, 2009-2014, and survival follow-up was as of December 31, 2019. The association between SII and psoriasis and its comorbidities was analyzed using weighted multivariate logistic regression models. Weighted COX regression was used to calculate hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Restricted cubic spline, subgroup and sensitivity analyses were also used. Logarithmic conversion was performed on SII(log2SII) to reduce the impact of outliers.

RESULTS

A total of 21,431 participants were included in this study. As a continuous variable, log2SII was significantly associated with psoriasis in the fully adjusted model [OR = 1.20(1.04-1.39), p = .01]. log2SII remained positively associated with psoriasis after excluding participants with a history of cancer or cardiovascular disease (CVD), or non-Hispanic black participants. Among psoriasis patients, log2SII was significantly associated with metabolic syndrome (MetS) [OR = 1.68(1.19,2.38), p = .004] and all-cause mortality [HR = 1.48(1.09,1.99), p = .01]. Similar results were consistently observed when SII was analyzed as a categorical variable (in quartiles).

CONCLUSION

This study suggested a positive association between SII and the prevalence of psoriasis. Among psoriasis patients, SII was positively correlated with MetS and all-cause mortality.

Molecular Characteristics and Pretreatment Neutrophil-to-Lymphocyte Ratio as Predictors of Durable Clinical Benefit from Immune Checkpoint Inhibition in Non-Small Cell Lung Cancer

BACKGROUND

Prior research in non-small cell lung cancer (NSCLC) has shown that tumors with specific driver mutations may be less likely to respond to immune checkpoint inhibitors (ICI). In this analysis, we evaluated the characteristics of patients with durable clinical benefit (DCB) to ICI compared to those with no durable clinical benefit (NDB), with emphasis on the role of molecular alterations in EGFR, ALK, and ROS1 and pretreatment neutrophil-to-lymphocyte ratio (NLR).

METHODS

We retrospectively collected clinical characteristics and outcomes for patients who initiated ICI monotherapy for advanced NSCLC at Stanford University between April 2015 and May 2018. Patients were classified as having DCB if time on ICI therapy was greater than or equal to 180 days, or NDB if less than 180 days. Outcomes included best radiographic benefit while on ICI and survival from time of ICI initiation.

RESULTS

Of 123 patients treated with ICI for NSCLC, 28 patients had DCB (23%), while 95 had NDB (77%). Median overall survival from initiation of ICI in the 33 patients with molecular alterations in EGFR (n = 31), ALK, or ROS1 and NLR of 5.9 or higher was 2.0 months, compared to 8.1 months in patients with these genomic alterations and NLR less than 5.9. Median overall survival in patients without alterations in EGFR, ALK, or ROS1 and NLR of 5.9 or higher was 4.3 months, compared to 12.1 months in patients with NLR less than 5.9 (P = .023).

CONCLUSIONS

Elevation in pretreatment NLR was associated with significantly lower overall median survival from initiation of ICI, particularly when in combination with NSCLC with alterations in EGFR, ALK, or ROS1. This finding could influence clinical practice as NLR is readily available through routine blood testing.

Effects of platelet-to-lymphocyte ratio on renal function following acute myocardial infarction: A retrospective observational study

Increased platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in acute myocardial infarction (AMI), which indicate accelerated thrombus formation and inflammatory response, potentially have prognostic implications. Given that cardiovascular disease and renal function exacerbate each other, an elevated PLR and NLR at admission for AMI may worsen renal function after AMI. However, only a few clinical studies have addressed this issue. Therefore, this study aimed to examine the effects of PLR and NLR at AMI onset on renal function. This retrospective study analyzed data from 234 patients hospitalized for AMI. First, correlations between various parameters (age; sex; body mass index; hemoglobin level, albumin level, B-type natriuretic peptide level, C-reactive protein level, creatinine (Cr) level, blood urea nitrogen (BUN) level, PLR, and NLR at admission; contrast medium usage; and maximum creatine kinase) and Cr and BUN levels at discharge were examined using single and multiple regression analyses. Then, correlations between these parameters and the change in Cr (ΔCr) and BUN levels (ΔBUN) were investigated using single and multiple regression analysis, followed by structural equation modeling (SEM). Multiple regression analysis revealed significant positive correlations between PLR at admission and Cr level at discharge (β = 0.135, P = .021), PLR at admission and BUN level at discharge (β = 0.218, P = .006), PLR at admission and ΔCr (β = 0.244, P = .019), and PLR at admission and ΔBUN (β = 0.312, P = .003). SEM results revealed significant positive correlations between PLR at admission and ΔCr (β = 0.260, P = .008) and PLR at admission and ΔBUN (β = 0.292, P = .003). Conversely, NLR demonstrated a minimal association with renal function at discharge compared to PLR. This study suggests that increased PLR at admission in AMI significantly affects and exacerbates renal function but does not increase NLR at admission. PLR is one of the predictors of renal dysfunction after AMI.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio: Side by Side with Molecular Mutations in Patients with Non-Small Cell Lung Cancer-The INOLUNG Study

Background and objective: Analysis of inflammatory biomarkers, along with the neutrophil/lymphocyte ratio (NLR) or platelet/lymphocyte ratio (PLR), supports the connection between inflammation and carcinogenesis. Methods: We conducted a retrospective observational study at the Clinical County Hospital Mureș involving patients with lung cancer. The parameters analyzed included histopathological type (NSCLC: squamous cell carcinoma or adenocarcinoma; SCLC), molecular mutations (EGFR, ALK, PD-L1), parameters from the complete blood count, inflammatory parameters, and associated comorbidities. Results: A total of 380 patients were included: 115 patients in the cancer group and 265 patients in the control group. Among patients in the lung cancer group, 88 were diagnosed with NSCLC (44 adenocarcinomas, 44 squamous cell carcinomas) and 27 with SCLC. Both NLR and PLR were significantly higher in cancer patients than in the control group (5.30 versus 2.60, p < 0.001; 217 versus 136, p < 0.001, respectively). NLR and PLR differ between men and women (p = 0.005 and p = 0.056, respectively). C-reactive protein was not correlated with either NLR (p-value: 0.0669) or PLR (p-value: 0.6733) in lung cancer patients. Conclusions: The NLR and PLR values may serve as new predictive biomarkers for the diagnosis of disease in patients with lung cancer, especially those with NSCLC.