Increasing Systemic Immune-inflammation Index During Treatment in Patients With Advanced Pancreatic Cancer is Associated With Poor Survival: A Retrospective, Multicenter, Cohort Study

Serum CEA as a Prognostic Marker for Overall Survival in Patients with Localized Pancreatic Adenocarcinoma and Non-Elevated CA19-9 Levels Treated with FOLFIRINOX as Initial Treatment: A TAPS Consortium Study

INTRODUCTION

About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a potential alternative.

METHODS

This retrospective cohort study from five referral centers included consecutive patients with localized pancreatic adenocarcinoma (2012-2019), treated with one or more cycles of (m)FOLFIRINOX, and non-elevated CA19-9 levels (i.e., < 37 U/mL) at baseline. Cox regression analyses were performed to assess prognostic factors for overall survival (OS), including CEA level at baseline, restaging, and dynamics.

RESULTS

Overall, 277 patients were included in this study. CEA at baseline was elevated (≥5 ng/mL) in 53 patients (33%) and normalized following preoperative therapy in 14 patients (26%). In patients with elevated CEA at baseline, median OS in patients with CEA normalization following preoperative therapy was 33 months versus 19 months in patients without CEA normalization (p = 0.088). At time of baseline, only elevated CEA was independently associated with (worse) OS (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.04-1.98). At time of restaging, elevated CEA at baseline was still the only independent predictor for (worse) OS (HR 1.44, 95% CI 1.04-1.98), whereas elevated CEA at restaging (HR 1.16, 95% CI 0.77-1.77) was not.

CONCLUSIONS

Serum CEA was elevated in one-third of patients with localized pancreatic adenocarcinoma having non-elevated CA19-9 at baseline. At both time of baseline and time of restaging, elevated serum CEA measured at baseline was the only predictor for (worse) OS. Therefore, serum CEA may be a useful tool for decision making at both initial staging and time of restaging in patients with non-elevated CA19-9.

Prognostic and clinicopathological role of pretreatment systemic immune-inflammation index in patients with oral squamous cell carcinoma: a meta-analysis

Background

There are many studies regarding the use of systemic immune-inflammation index (SII) to help predict oral squamous cell carcinoma (OSCC) prognosis, but findings have been inconsistent. The present meta-analysis was conducted to determine whether SII could contribute to predicting OSCC prognosis.

Methods

PubMed, Embase, Cochrane Library and Web of Science databases were thoroughly searched from their inceptions through August 20, 2023. The role of SII in predicting OSCC prognosis was determined through combined hazard ratios (HRs) with relevant 95% confidence intervals (CIs). Correlations of SII with clinicopathological characteristics of OSCC patients were analyzed based on combined odds ratios (ORs) with 95% CIs.

Results

This meta-analysis utilized 11 articles in total, involving 3,464 patients. According to the results, an elevated SII was markedly associated with dismal overall survival (OS) (HR=1.85, 95%CI=1.48-2.29, p<0.001) and poor disease-free survival (DFS) (HR=1.77, 95%CI=1.20-2.61, p=0.004) of OSCC. Moreover, a higher SII was markedly correlated with stage T3-T4 (OR=2.47, 95%CI=1.40-4.37, p=0.002), TNM stage III-IV (OR=2.29, 95%CI=1.53-3.44, p<0.001), and low differentiation (OR=1.74, 95%CI=1.25-2.43, p=0.001).

Conclusion

According to the present meta-analysis, an increased SII is significantly associated with dismal OS and DFS, advanced tumor stage and poor differentiation in OSCC. SII could be a potential and important biomarker for clinical management and predicting the prognosis of patients with OSCC.

Systematic review registration

https://inplasy.com/inplasy-2023-9-0033/), identifier INPLASY202390033.

Comprehensive analysis of the association between inflammation indexes and complications in patients undergoing pancreaticoduodenectomy

Background

During clinical practice, routine blood tests are commonly performed following pancreaticoduodenectomy (PD). However, the relationship between blood cell counts, inflammation-related indices, and postoperative complications remains unclear.

Method

We conducted a retrospective study, including patients who underwent PD from October 2018 to July 2023 at the First Hospital of Chongqing Medical University, and compared baseline characteristics and clinical outcomes among different groups. Neutrophil count (NC), platelet count (PLT), lymphocyte count (LC), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and the product of platelet count and neutrophil count (PPN) were derived from postoperative blood test results. We investigated the association between these indicators and outcomes using multivariable logistic regression and restricted cubic spline analysis. The predictive performance of these indicators was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

Result

A total of 232 patients were included in this study. Multivariate logistic regression and restricted cubic spline analysis showed that all indicators, except for PLT, were associated with clinical postoperative pancreatic fistula (POPF). SII, NLR, and NC were linked to surgical site infection (SSI), while SII, NLR, and PLR were correlated with CD3 complication. PLT levels were related to postoperative hemorrhage. SII (AUC: 0.729), NLR (AUC: 0.713), and NC (AUC: 0.706) effectively predicted clinical POPF.

Conclusion

In patients undergoing PD, postoperative inflammation-related indices and blood cell counts are associated with various complications. NLR and PLT can serve as primary indicators post-surgery for monitoring complications.

Prognostic and clinicopathological impacts of systemic immune-inflammation index on patients with diffuse large B-cell lymphoma: a meta-analysis

Background

The systemic immune-inflammation index (SII) represents the immunoinflammatory score and can be considered as a prognostic marker; however, its relevance to the prognosis in patients with diffuse large B-cell lymphoma (DLBCL) remains unclear.

Objectives

The present meta-analysis was conducted to comprehensively evaluate the relationship between the SII and prognosis in patients with DLBCL.

Design

This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Data sources and methods

The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to 16 March 2023. We calculated combined hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the prognostic significance of the SII for overall survival (OS) and progression-free survival (PFS) in DLBCL. In addition, this study determined odds ratios (ORs) and their 95% CIs to evaluate the correlation of SII with the clinicopathological features of DLBCL.

Results

Five articles including 592 cases were enrolled in the current meta-analysis. According to our combined findings, the higher SII significantly predicted worse OS (HR = 3.87, 95% CI: 2.48-6.04, p < 0.001) together with inferior PFS (HR = 2.38, 95% CI: 1.12-5.08, p = 0.024) in DLBCL. Furthermore, a high SII was significantly correlated with B symptoms (OR = 2.52, 95% CI: 1.66-3.81, p < 0.001), III-IV Ann Arbor stage (OR = 2.86, 95% CI: 1.84-4.45, p < 0.001), high-intermediate/high National Comprehensive Cancer Network International Prognostic Index (OR = 2.25, 95% CI: 1.52-3.31, p < 0.001), increased neutrophil-to-lymphocyte ratio (OR = 33.76, 95% CI: 17.18-66.35, p < 0.001), and increased platelet-to-lymphocyte ratio (OR = 44.65, 95% CI: 5.80-343.59, p < 0.001). Nonetheless, the SII was not significantly related to sex, age, lactic dehydrogenase level, Eastern Cooperative Oncology Group performance status, or histology.

Conclusion

According to this meta-analysis, the higher SII dramatically predicted inferior OS and PFS of DLBCL. Furthermore, an increased SII significantly correlated with some clinicopathological features representing the disease progression of DLBCL.

Trial registration

The protocol was registered in INPLASY under the number INPLASY202380106.

Surgical Considerations for Neoadjuvant Therapy for Pancreatic Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a challenging disease process with a 5-year survival rate of only 11%. Neoadjuvant therapy in patients with localized pancreatic cancer has multiple theoretical benefits, including improved patient selection for surgery, early delivery of systemic therapy, and assessment of response to therapy. Herein, we review key surgical considerations when selecting patients for neoadjuvant therapy and curative-intent resection. Accurate determination of resectability at diagnosis is critical and should be based on not only anatomic criteria but also biologic and clinical criteria to determine optimal treatment sequencing. Borderline resectable or locally advanced pancreatic cancer is best treated with neoadjuvant therapy and resection, including vascular resection and reconstruction when appropriate. Lastly, providing nutritional, prehabilitation, and supportive care interventions to improve patient fitness prior to surgical intervention and adequately address the adverse effects of therapy is critical.

Dynamics of the prognostic nutritional index in preoperative chemotherapy in patients with colorectal liver metastases

BACKGROUND

Identifying the prognostic indicators that reflect the efficacy of preoperative chemotherapy is necessary. In this study, we investigated the prognostic indicators targeting the systemic inflammatory response for the administration of preoperative chemotherapy in patients with colorectal liver metastases.

METHODS

Data for 192 patients were retrospectively analyzed. The relationship between overall survival and clinicopathological variables, including biomarkers such as the prognostic nutritional index, was investigated in patients who underwent upfront surgery or preoperative chemotherapy.

RESULTS

In the upfront surgery group, extrahepatic lesion (p=0.01) and low prognostic nutritional index (p < 0.01) were significant prognostic indicators, whereas a decrease in the prognostic nutritional index (p=0.01) during preoperative chemotherapy were independent poor prognostic factors in the preoperative chemotherapy group. In particular, a decrease in the prognostic nutritional index was a significant prognostic marker in patients aged <75 years (p=0.04). In patients with a low prognostic nutritional index aged <75 years, preoperative chemotherapy significantly prolonged overall survival (p=0.02).

CONCLUSION

A decrease in the prognostic nutritional index during preoperative chemotherapy predicted overall survival of patients with colorectal liver metastases after hepatic resection, and preoperative chemotherapy may be effective for patients aged <75 years with a low prognostic nutritional index.