The Relationship Between Systemic Immune Inflammatory Index and Prognosis of Patients With Non-Small Cell Lung Cancer: A Meta-Analysis and Systematic Review

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.

Comparing neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil count (ANC) and derived NLR as predictive biomarkers in first-line immunotherapy for non-small cell lung cancer: a retrospective study

Background

Lung cancer, especially non-small cell lung cancer (NSCLC), poses a significant global health challenge due to its high prevalence and poor prognosis despite treatment advancements, including immunotherapy. While programmed death-ligand 1 (PD-L1) expression is a commonly used biomarker, its limitations justify exploration of alternative markers like the neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil count (ANC) and derived NLR (dNLR). This retrospective study aims to directly compare NLR, ANC and dNLR as predictive biomarkers in first-line NSCLC immunotherapy, shedding light on their prognostic implications and potential clinical utility.

Methods

This retrospective single-center study included 70 consecutive patients diagnosed with metastatic NSCLC, treated in first-line with immune checkpoint inhibitors (ICIs) between September 2015 and March 2023 at the University Hospital of Reims, France. Baseline clinical characteristics and hematological values were collected, and survival analysis, including progression-free survival (PFS) and overall survival (OS), was performed based on RECIST (Response Evaluation Criteria in Solid Tumors) criteria. NLR and dNLR were calculated, and their predictive performances were assessed.

Results

Baseline characteristics revealed a median age of 65.5 years, predominantly adenocarcinoma histology (82.9%), and high PD-L1 expression (≥50%) in 61.4% of cases. Neither NLR, ANC nor dNLR showed significant associations with known clinical outcome influencers like age, PD-L1 expression, or performance status, but dNLR correlated significantly with initial response (P=0.02). While NLR ≥5 was significantly associated with shorter PFS and OS (P=0.03 and P<0.001, respectively), dNLR >2.5 (P=0.008) or ANC >7.5 (P=0.02) showed significance in predicting poorer OS only. Optimal cut-off values were determined as 5.0 for NLR [area under the curve (AUC) =0.570], 9.00 for ANC (AUC =0.683) and 2.496 for dNLR (AUC =0.610) for OS prediction. Cox regressions revealed no significant association between either biomarker and clinical or histological cofactors. Subgroup analyses suggested NLR's predictive consistency across various subgroups, whereas dNLR and ANC showed limited performance. Both biomarkers demonstrated significant association with OS in patients exposed to ICI alone, but not with chemotherapy combination.

Conclusions

The results underscore the potential of NLR as a predictor of survival and progression in NSCLC patients treated with immunotherapy, while dNLR and ANC demonstrate more limited interest. However, larger prospective studies are needed to confirm these observations and further elucidate their clinical utility.

Preoperative immune-inflammation index in predicting the diagnosis and adverse pathological features of prostate cancer

Background

Studies have reported that the systemic immune-inflammation index (SII) is positively correlated with genitourinary cancers. This study aims to explore the predictive value of preoperative immune-inflammation index for the diagnosis of prostate cancer and its adverse clinical characteristics.

Methods

This study analyzed patients who underwent their first prostate biopsy in the Urology Department of the Affiliated Hospital of Guangdong Medical University from January 2020 to January 2024. The predictive ability of SII for prostate cancer was evaluated, and the correlation between SII and localized prostate cancer and metastatic prostate cancer was explored.

Results

The SII in the PCa group was significantly higher than in the BPH group (558.14 vs. 515.06, P = 0.022), and SII independently predicted PCa risk (OR = 1.001, P = 0.013). Metastatic PCa patients exhibited higher SII compared to localized cases (694.80 vs. 437.95, P < 0.001), with multivariate analysis confirming SII, neutrophils, lymphocytes, and PSA as independent predictors of metastasis (OR = 1.000, P = 0.044). ROC analysis revealed limited predictive power of SII alone (AUC = 0.559), but its combination with PSA significantly improved accuracy (AUC = 0.791). A comprehensive model integrating SII, age, uric acid, and PSA achieved an AUC of 0.823, outperforming PSA alone (AUC = 0.777).

Conclusions

SII enhances the accuracy of PCa diagnosis and metastatic risk prediction when combined with PSA, demonstrating significant clinical utility. Although SII alone has limited predictive value, its cost-effectiveness and accessibility make it a valuable tool for stratified PCa management. Prospective studies are needed to validate its long-term prognostic significance.

Prognostic Value of Systemic Immune Inflammation Index in Squamous Cell Lung Cancer

Background/Objectives: Squamous cell lung cancer (SCC) presents a significant treatment challenge due to its poor prognosis and limited therapeutic options. In many resource-limited countries, access to advanced molecular testing is often unavailable, making the identification of novel and reliable prognostic markers crucial for improving patient selection for systemic treatments. Methods: This single-center, retrospective study investigated the prognostic value of inflammatory biomarkers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in 134 patients diagnosed with SCC. Patients were stratified into groups based on optimal cut-off values determined by ROC analysis for each biomarker. Results: Elevated levels of the SII, NLR, and PLR were significantly associated with shorter overall survival in patients with SCC (all p < 0.05). Conclusions: These easily accessible and cost-effective laboratory parameters are particularly valuable in settings where molecular testing is not available, aiding in the identification of high-risk patients and optimizing treatment selection for chemotherapy.

Association of systemic immune-inflammatory index with all-cause and cancer mortality in Americans aged 60 years and older

Background

This research delved into the association between the systemic immune-inflammatory index (SII) and both all-cause and cancer-specific mortality among individuals aged 60 years and above in the United States during the period from 1999 to 2018, with follow-up extending until 31 December 2019. The data utilized was sourced from 4295 population-based participants in the National Health and Nutrition Examination Survey (NHANES).

Methods

To analyze the relationship between SII and mortality, the study employed Cox proportional-risk models, restricted cubic spline curves, survival curves, and subgroup analyses.

Results

The average age of the participants was 70.7 (±7.6) years, the median follow-up duration was 131.7 (±59.8) months, and the all-cause mortality rate stood at 50.5%. Findings from the Cox regression model indicated that, after adjusting for covariates, SII was significantly and linearly related to all-cause mortality (hazard ratio HR = 1.31, 95% confidence interval CI = 1.15-1.48). Moreover, the relationship between SII and cancer mortality exhibited a U-shaped pattern. Results from the survival curves suggested that a higher SII was associated with an augmented risk of both all-cause mortality and cancer mortality.

Conclusion

There is a significant association between higher SII levels and increased risk of all-cause and cancer-specific mortality in the US population aged 60 years and older.

Diaphragm excursion difference as an adjunct predictor marker of postoperative pulmonary complications in video-assisted thoracoscopic surgery: a prospective, observational study

Background

Video-assisted thoracoscopic surgery (VATS) often leads to a significant number of postoperative pulmonary complications (PPCs). The diaphragm is the primary muscle involved in respiration. Diaphragm ultrasound is increasingly used as a noninvasive and portable tool for evaluating diaphragmatic contractile function. The diaphragm excursion difference (DED) provides a valuable predictive measure for clinical outcomes. This prospective, observational study aimed to evaluate the predictive feasibility of DED in relation to PPCs in patients undergoing VATS.

Methods

Between March and August 2023, a total of 151 patients undergoing VATS were enrolled in the study. Each patient underwent diaphragm ultrasound examinations both before anesthesia and within one hour after extubation. During these examinations, diaphragm excursion (DE) was recorded during quiet breathing (QB) and deep breathing (DB). The DED and diaphragm excursion fraction (DEF) were calculated at these two time points. The primary outcome measured was the incidence of major pulmonary complications occurring within seven days after surgery, while secondary outcomes included the rate of diaphragm dysfunction, duration of hospitalization, oxygenation status, and pain scores on the first and second postoperative days.

Results

Data from 151 patients were analyzed, revealing that 32 patients (21%) developed PPCs. Patients who developed PPCs exhibited a significantly lower postoperative diaphragm excursion during DB (2.27±0.59 vs. 3.31±0.99, P<0.001). They also showed a lower postoperative DED (0.94±0.44 vs. 1.94±0.91, P<0.001) and a higher DEF (0.59±0.13 vs. 0.44±0.12, P<0.001) compared to those without PPCs. In receiver operating characteristic curve analysis, the postoperative DED demonstrated a high sensitivity of 90.6% and a lower specificity of 64.7% for predicting PPCs, with an area under the curve (AUC) of 0.860 and a 95% confidence interval (CI) ranging from 0.788 to 0.926.

Conclusions

After VATS, lower postoperative DED may serve as an additional marker. This can help predict the risk of pulmonary complications.

Pretreatment systemic immune-inflammation index and lymphocyte-to-monocyte ratio as prognostic factors in oral cavity cancer: A meta-analysis

BACKGROUND

The predictive implications of the pretreatment systemic immune-inflammation index (SII) and lymphocyte-to-monocyte ratio (LMR) in oral cavity cancer have been investigated extensively, however, the findings are conflicting.

METHODS

To assess the predictive importance of SII and LMR in patients with oral cavity cancer, a comprehensive Meta-analysis of the literature was conducted using the databases from PubMed, Embase, and the Cochrane Library. To determine the link between SII and LMR and overall survival (OS) and disease-free survival (DFS), hazard ratio (HR) and 95% confidence interval (CI) were retrieved.

RESULTS

The analysis comprised a total of 18 papers, covering 19 trials (SII = 5, LMR = 12, SII + prognostic nutritional index (PNI) = 2). According to pooled data, increased SII predicted poor OS (HR: 1.61, 95% CI: 1.38-1.87, P < .001) and DFS (HR: 1.90, 95% CI: 1.11-3.27, P = .02) while high LMR was linked with improved OS (HR: 0.64, 95% CI: 0.54-0.77, P < .001) and DFS (HR: 0.69, 95% CI: 0.61-0.79, P < .001). In addition, subgroup analysis indicated that high SII and low LMR negatively correlated with OS regardless of country, cutoff value, sample size, or types of Cox regression analysis.

CONCLUSIONS

High SII and low LMR may predict worse survival in patients with oral cavity cancer. SII and LMR may therefore represent effective indicators of prognosis in oral cavity cancer.

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.

Preoperative prognostic nutritional index and systemic immune inflammation index for predicting the efficacy and survival time of patients with osteosarcoma undergoing neoadjuvant chemotherapy combined with surgery

OBJECTIVE

To explore the value of preoperative prognostic nutritional index (PNI) and systemic immune inflammation index (SII) for predicting the efficacy and prognosis of patients with osteosarcoma undergoing neoadjuvant chemotherapy (NACT) combined with surgery.

METHODS

A retrospective study was conducted on patients with osteosarcoma undergoing NACT combined with surgery in Sun Yat-sen University Cancer Center from January 2017 to May 2019. The patients were grouped into a remission group (pCR group, 85 patients) and a non-remission group (non-pCR, 79 patients), according to the treatment efficacy. The pathological data as well as clinical data were collected from patients, which were subsequently employed for statistical analysis to determine the factors affecting the efficacy of the treatment. The diagnostic value of PNI and SII for predicting the efficacy were assessed through following up the patients for 5 years to observe their overall survival rate. COX regression analysis was leveraged to identify risk factors affecting the survival time. The impact of different PNI and SII levels on the survival time was observed.

RESULTS

Multivariate regression analysis showed that factors including Enneking stage, PNI level and SII level were in association with poor efficacy after NATC combined with surgery. The mortality within 5 years was higher and the 5-year overall survival rate was lower in the non-pCR group than those in the pCR group (both P < 0.05). The COX regression analysis indicated that PNI and SII levels were risk factors for poor prognosis in patients with osteosarcoma following NACT combined with surgery. Further analysis showed that patients with low PNI and high SII levels had a lower 5-year survival rate (P < 0.05).

CONCLUSION

Enneking stage, PNI, and SII levels were risk factors for poor efficacy in patients with osteosarcoma after NACT combined with surgery. Patients whose PNI level was low and SII level was high presented poor prognosis following the treatment.

A novel inflammatory nutrient index for predicting survival outcomes in patients with non-small cell lung cancer

Background

Lung cancer is one of the most common contributors to cancer-related deaths worldwide. This study aimed to develop a new blood index on the basis of the patient's systemic inflammation and nutritional status, which can be used to predict the prognosis of patients with non-small cell lung cancer (NSCLC).

Methods

Pre-treatment blood markers were analyzed in 556 NSCLC patients from 2010 to 2019. A least absolute shrinkage and selection operator (LASSO) method was used to select indicators to establish a new integrated biomarker (PNAGR). Kaplan-Meier survival curves were used to assess the prognostic impact of platelet-to-lymphocyte ratio (PLR), albumin (ALB), and the PNAGR. The prognostic value was verified using univariate and multivariate Cox analyses.

Results

We used four biomarkers including PLR, ALB, 1/albumin-to-globulin ratio (1/AGR), and neutrophil/albumin-to-globulin ratio (N/AGR) were used to screen for the PNAGR using LASSO. Patients with high PNAGR demonstrated lower overall survival (OS) compared to those with low PNAGR. In both univariate and multivariate analyses, PNAGR was revealed as an independent prognostic factor for OS. The predictive power of PNAGR [area under the curve (AUC): 0.753] was higher than that of the metrics alone.

Conclusions

PNAGR is a novel and effective clinical prognostic tool with good clinical predictive value for NSCLC patients.

Rare Driver Mutations in Advanced, Oncogene-Addicted Non-Small Cell Lung Cancer: A North Italian, Real-World, Registry Experience

The real-world, retrospective, NEROnE registry investigated the impact of next-generation sequencing (NGS) in advanced non-small-cell lung cancer (NSCLC) patients (pts) at three oncology units in the north of Italy between January 2020 and December 2022. We focused on the clinical characterization and outcomes of NSCLC with rare molecular alterations: EGFR exon 20 insertion, non-activating EGFR mutations, BRAF V600E and non-V600, ROS1 and RET rearrangements, MET, ErbB2, and FGFR mutations. Overall, these represented 6.4% (62/970) of the pts analysed with NGS in the daily practice. The most heavily represented rare alterations were ROS1 rearrangement (15 pts-24%) and MET exon 14 skipping mutation (11 pts-18%). No associations were found with the demographic and clinical features. Forty-nine pts received targeted therapies, of which 38.8% were first- and 9.8% were second-line. The remaining pts received chemotherapy and/or immunotherapy. In terms of the clinical outcomes, although not statistically significant, a tendency toward shorter OS was seen when therapies other than specific targeted therapies were used (HR: 1.84, 95% CI: 0.79-4.33, p = 0.158). The pts with co-mutations (19.4%) seemed to receive an advantage from the front-line chemotherapy-based regimen. Finally, an NLR score (a well-known inflammatory index) ≥ 4 seemed to be related to shorter OS among the pts treated with immunotherapy alone or in combination with chemotherapy (HR: 2.83, 95% CI: 1.08-7.40, p = 0.033). Prospective evaluations need to be performed to clarify whether these indexes may help to identify patients with oncogene-addicted NSCLC who could benefit from immunotherapy.

Advances in systemic immune inflammatory indices in non-small cell lung cancer: A review

Lung cancer is one of the most prevalent cancers globally, with non-small cell lung cancers constituting the majority. These cancers have a high incidence and mortality rate. In recent years, a growing body of research has demonstrated the intricate link between inflammation and cancer, highlighting that inflammation and cancer are inextricably linked and that inflammation plays a pivotal role in cancer development, progression, and prognosis of cancer. The Systemic Immunoinflammatory Index (SII), comprising neutrophil, lymphocyte, and platelet counts, is a more comprehensive indicator of the host's systemic inflammation and immune status than a single inflammatory index. It is widely used in clinical practice due to its cost-effectiveness, simplicity, noninvasiveness, and ease of acquisition. This paper reviews the impact of SII on the development, progression, and prognosis of non-small cell lung cancer.

Prognostic value of pretreatment systemic immune-inflammation index in patients with endometrial cancer: a meta-analysis

Background: The present work focused on evaluating the systemic immune-inflammation index (SII) for its role in predicting endometrial cancer (EC) patient prognosis by meta-analysis. Methods: SII's role in predicting the prognosis of EC patients was analyzed by calculating combined hazard ratios (HRs) and 95% CIs. Results: As revealed by combined analysis, an increased SII predicted poor overall survival (HR = 2.01; 95% CI = 1.58-2.57; p < 0.001) as well as inferior progression-free survival (HR = 1.87; 95% CI = 1.36-2.58; p < 0.001) of EC. Conclusion: An increased SII score significantly predicted poor overall survival and progression-free survival in subjects with EC. The SII is suitable for predicting short- and long-term prognoses of patients with EC.

Prognostic Biomarkers of Systemic Inflammation in Non-Small Cell Lung Cancer: A Narrative Review of Challenges and Opportunities

Non-small cell lung cancer (NSCLC) is a common malignancy and is associated with poor survival outcomes. Biomarkers of systemic inflammation derived from blood tests collected as part of routine clinical care offer prognostic information for patients with NSCLC that may assist clinical decision making. They are an attractive tool, as they are inexpensive, easily measured, and reproducible in a variety of healthcare settings. Despite the wealth of evidence available to support them, these inflammatory biomarkers are not yet routinely used in clinical practice. In this narrative review, the key inflammatory indices reported in the literature and their prognostic significance in NSCLC are described. Key challenges limiting their clinical application are highlighted, including the need to define the optimal biomarker of systemic inflammation, a lack of understanding of the systemic inflammatory landscape of NSCLC as a heterogenous disease, and the lack of clinical relevance in reported outcomes. These challenges may be overcome with standardised recording and reporting of inflammatory biomarkers, clinicopathological factors, and survival outcomes. This will require a collaborative approach, to which this field of research lends itself. This work may be aided by the rise of data-driven research, including the potential to utilise modern electronic patient records and advanced data-analysis techniques.

Association between systemic immune-inflammation index and psoriasis: a population-based study

Background

The systemic immune-inflammation index (SII),as measured by lymphocyte, neutrophil and platelet counts in peripheral blood, is regarded as a favorable indicator of both inflammatory state and immune response. Psoriasis is an immune-mediated disease notable for its chronic inflammation of the entire system. Our research sought to explore the latent link between psoriasis and SII.

Methods

We performed a cross-sectional investigation utilizing data extracted from the National Health and Nutrition Examination Survey (NHANES, 2009-2014). Employing multivariate linear regression models and subgroup analysis, we sought to uncover the association between SII and psoriasis.

Results

This study enrolled a total of 17,913 participants as part of its research cohort. Our multivariate linear regression analysis revealed a notable and positive correlation between SII and psoriasis [1.013 (1.000, 1.026)]. As SII tertiles increased, the risk of psoriasis demonstrated an upward trend. The significant dependence on this positive association were maintained in women, BMI(≥ 30 kg/m2),non-stroke and non-cancer subjects in subgroup analysis and interaction tests. Furthermore, we identified a significant association between SII and psoriasis, characterized by two consecutive inverted U-shaped patterns. Notably, the analysis revealed the most prominent inflection point at a specific value of 797.067.

Conclusions

The results indicate a significant correlation between elevated SII levels and the presence of psoriasis. However, to corroborate and strengthen these results, additional large-scale prospective studies are required.

C-reactive protein to albumin ratio may predict in-hospital mortality in non-ST elevation myocardial infarction

Objective: The authors investigated the value of novel inflammatory markers, systemic immune-inflammation index and C-reactive protein to albumin ratio (CAR), to predict in-hospital mortality in patients with non-ST elevation myocardial infarction (NSTEMI). Materials & methods: A total of 308 patients who underwent percutaneous coronary intervention because of NSTEMI were retrospectively included in the study. Killip classification, Thrombolysis in Myocardial Infarction score, SYNTAX score, and CAR and systemic immune-inflammation index values were calculated. Results: CAR (cutoff: 0.0864; sensitivity: 94.1%; specificity: 40.5%; p = 0.008) and Killip classification (cutoff: 2.5; sensitivity: 64.7%; specificity: 8.9%; p = 0.001) were found to be significantly higher in determining in-hospital mortality. Conclusion: This study revealed that CAR is an inexpensive and significant factor in predicting in-hospital mortality in patients undergoing percutaneous coronary intervention for NSTEMI.

Evaluation of systemic immune-inflammatory index in patients with wet age-related macular degeneration

CLINICAL RELEVANCE

The systemic immune-inflammatory index is a relatively new parameter and has been shown to increase in inflammatory diseases.

BACKGROUND

The primary aim of this study was to investigate the systemic immune-inflammatory index in patients with wet-type age-related macular degeneration. The secondary aim was to determine the relationship between best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, systemic immune-inflammatory index, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio.

METHODS

This study retrospectively analysed patients with wet-type age-related macular degeneration between 2018 and 2022. Demographic data and peripheral complete blood count were obtained from the electronic medical record system. The most recent best-corrected visual acuity, central macular thickness, and subfoveal choroidal thickness values (within one month) for complete blood count were obtained from case sheets and the optical coherence tomography digital image database. The systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were calculated. Age- and sex-matched controls were also generated.

RESULTS

Thirty-three patients (23 males, 10 females) with wet-type age-related macular degeneration and 43 controls (24 males, 19 females) were included. The groups were similar in terms of age and sex (78.0 ± 6.3 vs. 75.6 ± 6.6 years, p = 0.59; p = 0.38 for sex). The systemic immune-inflammatory index was higher in the wet-type age-related macular degeneration group (460.5 vs. 440.4); however, this difference was not statistically significant. When the correlations between the systemic immune-inflammatory index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, best-corrected visual acuity (logMAR), central macular thickness, and subfoveal choroidal thickness were examined, there was only a moderate positive correlation between best-corrected visual acuity and platelet-to-lymphocyte ratio (r = 0.46, p = 0.007).

CONCLUSION

There were no differences in the systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio between the wet-type age-related macular degeneration and control groups. There was a positive correlation between the platelet-to-lymphocyte ratio and best-corrected visual acuity (logMAR). The systemic immune-inflammatory index was higher in patients with wet-type age-related macular degeneration than in the control group; however, this difference was not statistically significant.

The Value of Preoperative Systemic Immune-Inflammation Index as a Predictor of Prolonged Hospital Stay in Orthopedic Surgery: A Retrospective Study

Purpose

Many risk factors, such as the duration of surgery and higher ASA scores, are associated with longer hospitalization in patients undergoing orthopedic surgery. However, no studies have evaluated the relationship between the preoperative systemic immune-inflammation index (SII) and length of hospital stay in orthopedic surgical patients. Therefore, this study aimed to investigate whether the SII is associated with the length of hospital stay in orthopedic surgery in adults.

Patients and Methods

This was a retrospective cohort study, and data were extracted from electronic health records. Patients were included if they were older than 18 years and had undergone orthopedic surgery between [2016-2021]. The patients were divided into two groups according to the median duration of hospitalization and according to SII cut-off value (high-SII group: ≥799.86, low-SII group: <799.86). Univariate and multivariate linear regression analyses were used to identify the association between SII and length of hospitalization.

Results

A total of 196 patients who underwent orthopedic surgery were included, and 62 were hospitalized for >21 days. There were significant differences in terms of ASA score (P = 0.041). Patients who required a longer hospitalization of >21 days had significantly lower hemoglobin level (P < 0.001), higher duration of surgery (P = 0.015), and increased requirement of ICU admission (P < 0.001). The optimal cut-off value for preoperative SII of 799.86 stratified the patients into high-SII and low-SII groups. Patients in high-SII group had higher median LOHS (22 days) compared to low-SII group (17 days; P = 0.006). In the multivariable linear regression analysis, the SII was significantly related to the length of hospital stay (β = 0.246, 95% confidence interval [CI] 0.000-0.005, P = 0.031).

Conclusion

A high-SII value is associated with an increased risk of longer hospitalization after orthopedic surgery.

Hemoglobin and neutrophil levels stratified according to International Metastatic Renal Cell Carcinoma Database Consortium risk predict the effectiveness of ipilimumab plus nivolumab in patients with advanced metastatic renal cell carcinoma

OBJECTIVE

To identify biomarkers associated with the effectiveness of ipilimumab plus nivolumab against advanced metastatic renal cell carcinoma.

METHODS

We retrospectively analyzed the data of 75 patients treated with ipilimumab plus nivolumab at seven hospitals between August 2018 and April 2021. Prognostic biomarkers were assessed prior to initiating treatment with ipilimumab plus nivolumab. Median overall survival and progression-free survival were examined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify predictors of disease progression. The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk factors most important for predicting disease progression were determined using classification and regression tree analysis.

RESULTS

Median overall survival and progression-free survival were longer in the intermediate IMDC risk group than in the poor IMDC risk group (overall: not reached vs. 18.3 months; progression-free: not reached vs. 13.5 months). The multivariate analysis identified poor IMDC risk as a risk factor for disease progression (hazard ratio 2.61, 95% confidence interval: 1.05-6.51). Based on the results of the classification and regression tree analysis, the cohort was divided into non-anemia, anemia + neutro-Low, and anemia + neutro-High groups. Median overall survival and progression-free survival were longer in the non-anemia and anemia + neutro-Low groups than in the anemia + neutro-High group (overall: not reached vs. 29.3 months vs. 4.3 months: progression-free: not reached vs. 29.0 months vs. 3.9 months).

CONCLUSION

Hemoglobin and neutrophil levels may represent crucial biomarkers for predicting the effectiveness of ipilimumab plus nivolumab therapy in patients with renal cell carcinoma.

Soluble biomarkers to predict clinical outcomes in non-small cell lung cancer treated by immune checkpoints inhibitors

Lung cancer remains the first cause of cancer-related death despite many therapeutic innovations, including immune checkpoint inhibitors (ICI). ICI are now well used in daily practice at late metastatic stages and locally advanced stages after a chemo-radiation. ICI are also emerging in the peri-operative context. However, all patients do not benefit from ICI and even suffer from additional immune side effects. A current challenge remains to identify patients eligible for ICI and benefiting from these drugs. Currently, the prediction of ICI response is only supported by Programmed death-ligand 1 (PD-L1) tumor expression with perfectible results and limitations inherent to tumor-biopsy specimen analysis. Here, we reviewed alternative markers based on liquid biopsy and focused on the most promising biomarkers to modify clinical practice, including non-tumoral blood cell count such as absolute neutrophil counts, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and derived neutrophil to lymphocyte ratio. We also discussed soluble-derived immune checkpoint-related products such as sPD-L1, circulating tumor cells (detection, count, and marker expression), and circulating tumor DNA-related products. Finally, we explored perspectives for liquid biopsies in the immune landscape and discussed how they could be implemented into lung cancer management with a potential biological-driven decision.

Prognostic role of the pretreatment systemic immune-inflammation index in patients with glioma: A meta-analysis

Background

The systemic immune-inflammation index (SII) has been recognized as the indicator that reflects the status of immune responses. The SII is related to the prognostic outcome of many malignancies, whereas its role in gliomas is controversial. For patients with glioma, we, therefore, conducted a meta-analysis to determine if the SII has a prognostic value.

Methods

Studies relevant to this topic were searched from 16 October 2022 in several databases. In patients with glioma, the relation of the SII level with the patient prognosis was analyzed based on hazard ratios (HRs) as well as corresponding 95% confidence intervals (CIs). Moreover, subgroup analysis was conducted to examine a possible heterogeneity source.

Results

There were eight articles involving 1,426 cases enrolled in the present meta-analysis. The increased SII level predicted the dismal overall survival (OS) (HR = 1.81, 95% CI = 1.55–2.12, p &lt; 0.001) of glioma cases. Furthermore, an increased SII level also predicted the prognosis of progression-free survival (PFS) (HR = 1.87, 95% CI = 1.44–2.43, p &lt; 0.001) in gliomas. An increased SII was significantly associated with a Ki-67 index of ≥30% (OR = 1.72, 95% CI = 1.10–2.69, p = 0.017). However, a high SII was not correlated with gender (OR = 1.05, 95% CI = 0.78–1.41, p = 0.734), KPS score (OR = 0.64, 95% CI = 0.17–2.37, p = 0.505), or symptom duration (OR 1.22, 95% CI 0.37–4.06, p = 0.745).

Conclusion

There was a significant relation between an increased SII level with poor OS and the PFS of glioma cases. Moreover, patients with glioma with a high SII value have a positive relationship with a Ki-67 of ≥30%.

Prognostic value of the pretreatment systemic immune-inflammation index in patients with prostate cancer: a systematic review and meta-analysis

BACKGROUND

The systemic immune-inflammation index (SII) is a novel biomarker to predict the prognosis of some malignant tumors based on neutrophil, platelet, and lymphocyte counts. Evidence is scarce about the prognostic value of SII for prostate cancer patients. This systematic review and meta-analysis was conducted to explore the prognostic value of the SII in prostate cancer.

METHODS

The PubMed, Embase, Web of Science, and Cochrane Library (CENTRAL) databases were searched to determine eligible studies from inception to August 15, 2022. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to pool the results. Statistical analyses were conducted by using Stata 17.0 software.

RESULTS

A total of 12 studies with 8083 patients were included. The quantitative synthesis showed that a high SII was related to poor overall survival (OS) (HR = 1.44, 95% CI 1.23-1.69, p < 0.001). Furthermore, a subgroup analysis showed that a high SII was associated with poor OS in the groups of any ethnicity, tumor type, and cutoff value. An increased SII was also associated with inferior progression-free survival (PFS) (HR = 1.80, 95% CI 1.27-2.56, p = 0.001). In the subgroup analysis, a high SII value was related to poor PFS in Asian patients (HR = 4.03, 95% CI 1.07-15.17, p = 0.04) and a cutoff value > 580 (HR = 1.19, 95% CI 1.04-1.36, p = 0.01).

CONCLUSION

Based on the current evidence, a high pretreatment SII may be associated with poor OS and PFS. The SII may serve as an important prognostic indicator in patients with prostate cancer. More rigorously designed studies are needed to explore the SII and the prognosis of prostate cancer.

Systemic immune-inflammation index is associated with decreased bone mass density and osteoporosis in postmenopausal women but not in premenopausal women

PURPOSE

This study aims to investigate the associations of the systemic immune-inflammation index (SII) with bone mineral density (BMD) and osteoporosis in adult females from a nationally representative sample.

METHODS

A cross-sectional study was performed among 4092 females aged ≥20 years from the National Health and Nutrition Examination Survey 2007-2010. Linear and logistic regressions were applied to explore the relationships of SII with BMD and the risk of osteoporosis, respectively.

RESULTS

Linear regression analyses found that a doubling of SII levels was significantly correlated with a 1.39% (95% CI: 0.57%, 2.20%) decrease in total femur BMD, a 1.16% (95% CI: 0.31%, 2.00%) decrease in femur neck BMD, a 1.73% (95% CI: 0.78%, 2.66%) decrease in trochanter BMD, and a 1.35% (95% CI: 0.50%, 2.20%) decrease in intertrochanteric BMD among postmenopausal women, after adjusting for covariates. Logistic regression analyses showed that compared with postmenopausal women in the lowest SII quartile, those in the highest quartile had higher risks of osteoporosis in the total femur (odds ratio (OR) = 1.70, 95% CI: 1.04, 2.76), trochanter (OR = 1.86, 95% CI: 1.07, 3.38), intertrochanter (OR = 2.01, 95% CI: 1.05, 4.04) as well as overall osteoporosis (OR = 1.57, 95% CI: 1.04, 2.37). In contrast, there was no significant association between SII and BMD in premenopausal women.

CONCLUSIONS

SII levels were negatively associated with BMD levels in postmenopausal women but not in premenopausal women. Elevated SII levels could be a potential risk factor for osteoporosis in postmenopausal women.

The mechanism of Bai He Gu Jin Tang against non-small cell lung cancer revealed by network pharmacology and molecular docking

BACKGROUND

Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related burden and deaths, thus effective treatment strategies with lower side effects for NSCLC are urgently needed. To systematically analyze the mechanism of Bai He Gu Jin Tang (BHGJT) against NSCLC by network pharmacology and molecular docking.

METHODS

The active compounds of BHGJT were obtained by searching the Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine and Encyclopaedia of Traditional Chinese Medicine. Search tool for interactions of chemicals was used for acquiring the targets of BHGJT. The component-target network was mapped by Cytoscape. NSCLC-related genes were obtained by searching Genecards, DrugBank and Therapeutic Target Database. The protein-protein interaction network of intersection targets was established based on Search Tool for Recurring Instances of Neighboring Genes (STRING), and further, the therapeutic core targets were selected by topological parameters. The hub targets were transmitted to Database for Annotation, Visualization and Integrated Discovery for gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Finally, AutoDock Vina and MglTools were employed for molecular docking validation.

RESULTS

Two hundred fifty-six compounds and 237 putative targets of BHGJT-related active compounds as well as 1721potential targets of NSCLC were retrieved. Network analysis showed that 8 active compounds of BHGJT including kaempferol, quercetin, luteolin, isorhamnetin, beta-sitosterol, stigmasterol, mairin and liquiritigenin as well as 15 hub targets such as AKR1B10 and AKR1C2 contribute to the treatment of BHGJT against NSCLC. GO functional enrichment analysis shows that BHGJT could regulate many biological processes, such as apoptotic process. Three modules of the endocrine related pathways including the inflammation, hypoxia related pathways as well as the other cancer related pathways based on Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis might explain the biological mechanisms of BHGJT in treating BHGJT. The results of molecular docking verified that AKR1B10 and AKR1C2 had the strongest binding activity with the 8 key compounds of NSCLC.

CONCLUSION

Our study reveals the mechanism of BHGJT in treating NSCLC involving multiple components, multiple targets and multiple pathways. The present study laid an initial foundation for the subsequent research and clinical application of BHGJT and its active compounds against NSCLC.

Sleep Characteristics and Cancer-Related Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies

BACKGROUND

Sleep is closely related to various diseases. Several meta-analyses have provided evidence of sleep and cancer, and yet the credibility of this evidence has not been comprehensively quantified. Thus, we conducted an umbrella review to quantify the evidence for systematic reviews and meta-analyses of observational studies on sleep characteristics (sleep duration, sleep quality, napping, bedtime, and wake-up time) and cancer-related outcomes.

METHODS

PubMed, Web of Science (Core Collection), and Embase databases were searched from inception until 29 July 2022. Assessment of Multiple Systematic Reviews, version 1, was used to evaluate the methodological quality of each eligible systematic review or meta-analysis. For each association, the summary effect with a 95% confidence interval was evaluated by fixed and random effects models. The 95% prediction interval, heterogeneity, small-study effects, and excess significance bias were also evaluated. Evidence of the associations from systematic reviews and meta-analyses was ranked based on the established criteria of published literature as convincing, highly suggestive, suggestive, weak, or non-significant.

RESULTS

The umbrella review identified thirty meta-analyses on the aforementioned associations from six articles. The methodological quality of five articles was high or moderate. Suggestive evidence was found for associations between long sleep duration and a 21% increased risk of colorectal cancer, a 9% increased all-cancer mortality and a 65% increased mortality of lung cancer, and associations between short sleep duration and a 21% increased mortality of lung cancer. Additionally, the evidence of associations between short sleep duration and lung cancer mortality was upgraded to convincing, and between long sleep duration and lung cancer mortality was upgraded to highly suggestive, among the population reporting 24 h sleep duration.

CONCLUSION

Abnormal sleep duration might be linked to several adverse cancer-related outcomes.