High Systemic Immune-Inflammation Index Values Before Treatment Predict Poor Pancreatic Cancer Outcomes After Definitive Chemoradiotherapy

Topkan E. Kucuk A. Ozturk D. Ozkan E.E. Kılıç Durankuş N. Şenyürek Ş. Selek U. Pehlivan B.
January-December 2024 SAGE Publications Ltd

Clinical Medicine Insights: Oncology
2024 #18

Background: The systemic immune-inflammation index (SII) is an effective tool for predicting the prognosis of patients with cancer. However, its value in patients with locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) undergoing definitive chemoradiotherapy has yet to be addressed. Therefore, we aimed to retrospectively investigate the prognostic significance of the pretreatment SII on the survival outcomes of patients with unresectable LA-PDAC treated with concurrent chemoradiotherapy (C-CRT). Methods: The study included 163 patients with LA-PDAC who had received C-CRT. Using receiver operating characteristic (ROC) curve analysis, the utility of a pre-C-CRT cutoff that could stratify survival results was investigated. The primary and secondary endpoints were the correlations between SII levels and overall survival (OS) and progression-free survival (PFS). Results: At a median follow-up period of 15 months (range: 3.2-94.5), the median OS and PFS rates for the entire group were 15.7 months (95% confidence interval [CI]: 13.4-17.9), and 7.8 months (95% CI: 6.1-9.4), respectively. We divided the patients into 2 SII cohorts based on the ROC curve analysis (area under the curve [AUC]: 71.9%; sensitivity: 68.9%; specificity: 66.7%): SII < 538 (N = 70) and SII ⩾ 538 (N = 93). Comparative survival analysis showed significantly inferior median OS (13.0 vs 25.4 months; P <.001) and PFS (7.0 vs 15.2 months; P =.003) in patients with SII ⩾ 538 compared with those with SII < 538 before treatment. In multivariate analyses, the Eastern Cooperative Oncology Group (ECOG) performance of 2, N1-2 lymph node, CA 19-9 > 90 U/mL, and SII ⩾ 538 status emerged as independent prognosticators of inferior OS and PFS. Conclusions: Present results indicate that patients with unresectable LA-PDAC who underwent C-CRT and had a pretreatment SII ⩾ 538 had significantly worse OS and PFS outcomes compared with those with lower SII values.

concurrent chemoradiotherapy , Pancreas adenocarcinoma , prognosis , survival outcomes , systemic-immune-inflammation index

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Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
Clinic of Radiation Oncology, Mersin Education and Research Hospital, Mersin, Turkey
Department of Radiation Oncology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
Department of Radiation Oncology, Suleyman Demirel University, Isparta, Kazakhstan
Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey

Department of Radiation Oncology
Clinic of Radiation Oncology
Department of Radiation Oncology
Department of Radiation Oncology
Department of Radiation Oncology
Department of Radiation Oncology

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