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SUMMARY OBJECTIVE: Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. METHODS: The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. RESULTS: Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p

Aim: Systemic immune-inflammation indexes have been reported to be associated with clinical outcomes in several malignancies. Herein, we aimed to evaluate the potential relationship between prognostic nutritional index (PNI), systemic immune-inflammation index (SII), the neutrophil- to- lymphocyte ratio (NLR), the monocyte- to- lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) and the treatment response in patients with esophageal cancer who underwent neoadjuvant chemoradiotherapy (CRT).Material and Method: Esophageal cancer (EC) patients who underwent neoadjuvant CRT were retrospectively enrolled in the study. Immune-inflammation indexes were calculated from pretreatment blood counts in samples obtained. The relationships between PNI, SII, NLR, MLR, PLR values, treatment response, and overall survival (OS) rates were examined.Results: The data of 103 patients with EC who were referred to the Radiation Oncology Clinic of Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital were retrospectively analyzed. In the univariate analysis for OS, alcohol consumption, CRT agent, NLR, MLR, PLR, SII and PNI were found as prognostic factors. Also alcohol consumption was found as an independent prognostic factor in multivariate analyzes (HR:5.201, 95% CI:1.9-14.2, p=0.01). Conclusion: In our study, high SII and low PNI values ​​were not found to be independent poor prognostic factors for OS, but lower OS rates were observed in patients with high SII and low PNI values.

Acute Odontogenic Infections (OI) are the leading cause of emergency visits and hospitalizations to the maxillofacial department, and may induce systemic inflammatory complications. Increasing numbers of OI patients need extended hospitalizations, various treatments, and intensive care. The Symptom Severity score (SS) helps doctors assess the likelihood of infection and admission complications. Systemic Immune-inflammation Index (SII) is a biomarker-based inflammatory prognosis score. It was hypothesized that greater SII and SS values might suggest a higher risk for sepsis and systemic inflammatory response syndrome (SIRS). Therefore, this research aims to discover whether SII and SS scores can reliably predict odontogenic infection severity and prognosis, and if they can be used to predict the development of SIRS and sepsis in OI using admission features. The study was designed as a retrospective cohort, with patients’ data being retrieved from medical records between January 2017 to April 2022. A total of 108 OI patients were matched 1:1 as low-severity and high-severity groups. Most individuals with severe infections had diabetes and smoking as comorbidities. Severe patients had longer hospital stays (12.0 days vs. 4.1 days), although mortality rates did not significantly differ. A total of 11.1% lower-severity patients (Group A) had SIRS during hospitalization, compared to Group B with 25.9%. Group A had 7.4% of patients that developed sepsis compared to Group B’s rate of 22.2%. The correlation between OI’s SS and SII index values was positive and statistically significant (r = 0.6314). The total SII index mean was 1303, whereas the mean values by severity were 696.3 in Group A and 2312.4 in Group B. Group A’s mean SS score was 6.1, while Group B’s was 13.6. According to the calculated AUC plots, SII and SS scores were accurate predictors of sepsis and SIRS development using OI admission parameters. The adjusted odds ratio for SIRS in OI patients was 2.09, and 2.27 for sepsis. Medical professionals and dentistry teams should be encouraged to use the SII and SS scores to diagnose and anticipate sepsis and SIRS, hence improving disease management decisions.

Background: to evaluate the utility of pretreatment systemic immune-inflammation index (SII) in predicting the teeth caries and need for tooth extraction after concurrent chemoradiotherapy (C-CRT) for locally advanced squamous-cell head and neck cancer (LASCHNC) patients. Methods: the records of LA-SCHNC patients who underwent formal dental evaluations at pre and post-C-CRT periods were retrospectively analyzed. The pretreatment SII values were calculated using the platelet, neutrophil, and lymphocyte measures acquired on the first day of C-CRT: SII=Plateletsxneutrophils/lymphocytes. Receiver operating characteristic (ROC) curve analysis was employed to identify the ideal pre-C-CRT SII cutoff that may predict the teeth caries and the need for tooth extraction after the C-CRT. The primary endpoint was the link between the pre-C-CRT SII and the need for tooth extraction during the follow-up period. Results: a sum of 126 patients were included. Median follow-up was 4.9 years (range: 2.7-7.8). Nasopharyngeal and laryngeal cancers comprised the majority (75.4%) study cohort. Posttreatment teeth extractions were reported in 62.7% patients. The optimal cutoff was 558 [Area under the curve (AUC): %76.8 sensitivity: 72.3%; and specificity: 70.9%] that grouped the patients into two subgroups with significantly different post-C-CRT tooth extraction rates: Group 1: SII558 (n = 56), respectively. Correlation analysis revealed a significant relationship between the pretreatment SII and the tooth extraction rates after the C-CRT (rs:0.89: P = 0.001). The comparative analysis displayed that the teeth extractions rates were significantly higher in the SII>558 group (77.1% versus 51.4% for SII558 was the unique factor associated with meaningfully higher necessities for post-C-CRT teeth extractions. Conclusion: the present outcomes intimated that high pretreatment SII levels were linked to significantly increased post-treatment teeth extractions in LA-SCHNC patients undergoing definitive C-CRT., NA

Objective Inflammation plays a critical role in atherosclerosis. This study examines the effects of ticagrelor and clopidogrel on inflammatory parameters, obtained from complete blood count (CBC) and biochemical measurements, in patients with acute coronary syndrome. Methods and Results One hundred acute coronary syndrome (ACS) patients were included in the study and grouped according to clopidogrel (n = 50) or ticagrelor (n = 50) usage as an anti-aggregant (with acetylsalicylic acid). All patients underwent percutaneous coronary intervention. On admission, at third- and sixth-month after ACS, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein ratio (MHR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from the CBC and biochemical measurements. NLR, PLR, and SII were significantly lower in the ticagrelor group (p < 0.001, at 3rd and 6th month). Also, MHR was lower in the ticagrelor group (p < 0.05). Conversely, WBC count was higher in the ticagrelor group (p < 0.001). Conclusions NLR, MHR, PLR, and SII levels were lower in ACS patients treating with ticagrelor. Ticagrelor may improve these inflammatory parameters in percutaneous coronary intervention (PCI)-treated ACS patients compared to clopidogrel.

Aim:The neutrophil-lymphocyte ratio (NLR) is a parameter that has been shown to be effective as a prognostic marker in many solid tumors. It is aimed to investigate NLR and the systemic immune-inflammation index (SII) in predicting the overall survival and lymph node positivity in bladder cancer (BC).Methods:The retrospective study included patients that underwent radical cystoprostatectomy/radical cystectomy (RC) due to muscle-invasive bladder cancer (MIBC), high-grade T1 BC, or carcinoma in situ in our clinic between January 2010 and March 2020. All the patients had no history of preoperative metastasis, lymph nodes, chemotherapy, hematological malignancies, and preoperative urinary tract infection. Data on neutrophil, lymphocyte, platelet, and hemoglobin levels and total white blood cell counts were retrieved from clinical records and data on disease stage and lymph node positivity were retrieved from pathology reports. Follow-up times and survival times were recorded.Results:The 213 patients comprised 196 (92%) men and 17 (8%) women with a mean age of 63.17±11.25 years. Lymph node positivity was detected in 49 (23%) patients. The mean overall survival time was 75.04, 63.77, and 84.4 months in all patients, patients with lymph node positivity, and patients with lymph node negativity, respectively. No significant difference was found between patients with lymph node positivity and negativity with regard to NLR and SII values (p=0.975 and p=0.745, respectively). In the receiver operating characteristics (ROC) analysis NLR and SII had no significant effect in predicting lymph node positivity [Area under the ROC curve (AUC) 0.499 (95% confidence interval (CI): 0.403-0.594) and AUC 0.485 (95% CI: 0.394-0.575), respectively] and in predicting overall survival [AUC 0.423 (95% CI: 0.346-0.501, p=0.056) and AUC 0.435 (95% CI: 0.357-0.514, p=0.107), respectively].Conclusion:The results indicated that SII and NLR are not sufficient to predict lymph node positivity and survival in patients with organ-confined BC.

Adipose-derived mesenchymal stem cells (Ad-MSCs) exhibit anti-inflammatory and immunomodulatory activities. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) have been reported as novel biomarkers of the inflammatory state; however, they have never been examined in dogs with chronic inflammatory enteropathy (CIE) treated with Ad-MSCs. This study aimed to compare the clinical evolution and the changes in the NLR, PLR, and SII in dogs with CIE before and after cell therapy. Sixteen dogs with CIE were administered a single intravenous dose of Ad-MSCs. The canine chronic enteropathy clinical activity index (CCECAI), NLR, PLR, and SII were assessed before treatment (T0) and at 2 (T2) and 9 (T9) months post-treatment and compared over time and with the reference values obtained from a group of healthy dogs. NLR, PLR, and SII were significantly increased at T0 compared to the reference values, decreasing significantly over time. At T9, the NLR and SII did not differ from the reference values, but PLR remained above the reference values. A correlation was observed between CCECAI and the three markers. These findings show that the clinical improvement of dogs with CIE treated with Ad-MSCs is accompanied by a normalization of the inflammatory status.

The selection of candidates for the curative treatment of PCa requires a careful assessment of life expectancy. Recently, blood-count inflammatory markers have been introduced as prognosticators of oncological and non-oncological outcomes in different settings. This retrospective, monocentric study included 421 patients treated with radical prostatectomy (RP) for nonmetastatic PCa and aimed at determining the utility of a preoperative SII (neutrophil count × platelet count/lymphocyte count) in predicting survival after RP. Patients with high SIIs (≥900) presented significantly shorter survival (p = 0.02) and high SIIs constituted an independent predictor of overall survival [HR 2.54 (95%CI 1.24–5.21); p = 0.01] when adjusted for high (≥6) age-adjusted CCI (ACCI) [HR 2.75 (95%CI 1.27–5.95); p = 0.01] and high (≥6) CAPRA-S [HR 2.65 (95%CI 1.32–5.31); p = 0.006]. Patients with high scores (ACCI and/or CAPRA-S) and high SIIs were at the highest risk of death (p < 0.0001) with approximately a one-year survival loss during the first seven years after surgery. In subgroup of high CAPRA-S (≥6), patients with high ACCIs and high SIIs were at the highest risk of death (p

Inflammation plays a significant role in the occurrence and development of acute kidney injury (AKI). Evidence regarding the prognostic effect of the systemic immune-inflammation index (SII) in critically ill patients with AKI is scarce. The aim of this study was to assess the association between SII and all-cause mortality in these patients. Detailed clinical data were extracted from the Medical Information Mart for Intensive Care Database (MIMIC)-IV. The primary outcome was set as the in-hospital mortality. A total of 10,764 AKI patients were enrolled in this study. The restricted cubic splines analyses showed a J-shaped curve between SII and the risk of in-hospital and ICU mortality. After adjusting for relevant confounders, multivariate Cox regression analysis showed that both lower and higher SII levels were associated with an elevated risk of in-hospital all-cause mortality. A similar trend was observed for ICU mortality. In summary, we found that the SII was associated in a J-shaped pattern with all-cause mortality among critically ill patients with AKI. SII appears to be have potential applications in the clinical setting as a novel and easily accessible biomarker for predicting the prognosis of AKI patients.

BACKGROUND The inverse association between systemic immune-inflammation index (SII) and overall survival in tumors has been studied. AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis (UC). METHODS In this case-control study, 172 UC patients and healthy participants were included. Comparisons were made among groups of white blood cells, hemoglobin, platelets, neutrophils, lymphocytes, monocytes, SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The relationship with hematological inflammation was verified by Spearman correlation analyses. The efficiency of SII, NLR, and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses. RESULTS The values of SII, NLR, and PLR were higher in UC patients than in controls (P < 0.001) and were positively correlated with the Mayo endoscopic score, extent, Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUBLIN) score, and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65% and a specificity of 76.16%. Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC (P < 0.05). Risk factors independently associated with DUBLIN ≥ 3 included SII ≥ 1776.80 [odds ratio (OR) = 11.53, P = 0.027] and NLR value of 2.67-4.23 (OR = 2.96, P = 0.047) on multivariate analysis. Compared with the first quartile, SII ≥ 1776.80 was an independent predictor of UCEIS ≥ 5 (OR = 18.46, P = 0.012). CONCLUSION SII has a certain value in confirming UC and identifying its activity.

Jie Wang,1 Depu Zhou,1 Zhijuan Dai,2 Xiaokun Li1 1Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin, People’s Republic of China; 2Department of Endocrinology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Xiaokun LiDepartment of Endocrinology, Yanbian University Hospital, Yanji, Jilin, People’s Republic of ChinaEmail profxiaokunli@163.comBackground: Depression is highly prevalent in patients with diabetes mellitus (DM). Diabetic depression has been shown to be associated with low-grade systemic inflammation. In recent years, the systemic immune-inflammation (SII) index has been developed as an integrated and novel inflammatory indicator. The aims of this study were to investigate the relationship between diabetic depression and SII levels, adjusting for a wide range of potential confounding factors, to examine the potential of SII in predicting diabetic depression.Methods: The present cross-sectional study was conducted among adults with DM in the National Health and Nutrition Examination Survey between 2009 and 2016, the SII level was calculated as the platelet counts × neutrophil counts/lymphocyte counts. Patient Health Questionnaire‐9 was used to measure depression in patients with DM. Multivariable logistic regression and propensity score-matched analysis were used to analyze the association between SII levels and depression.Results: A total of 2566 patients with DM were included in the study, of which 370 (13.3%) were diagnosed with depression. Multivariable logistic regression showed that high SII level was an independent risk factor for diabetic depression (OR = 1.347, 95% CI: 1.031– 1.760, P = 0.02882) after adjusting for covariates. The relationship between SII and diabetic depression was further verified by propensity score-matched analysis.Conclusion: Our data suggest that SII is a risk factor for depression in patients with DM. The SII may be an easily accessible and cost-effective strategy for identifying depression in patients with DM. More studies are warranted to further analyze the role of SII in depression in diabetic patients.Keywords: systemic immune-inflammation index, depressive symptoms, diabetes mellitus, NHANES

BackgroundPrevious studies have investigated the prognostic value of the systemic immune-inflammation index (SII) in small cell lung cancer (SCLC). However, the results have been inconsistent. The study aimed to investigate the prognostic and clinicopathological significance of SII in SCLC through a meta-analysis.MethodsThe PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure databases were thoroughly searched. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of the SII for survival outcomes. The combined odds ratios (ORs) and 95% CIs were used to evaluate the correlation between SII and clinicopathological features.ResultsEight studies comprising 2,267 patients were included in the meta-analysis. Pooled analyses indicated that a high SII was significantly associated with worse overall survival (OS) (HR=1.52, 95% CI=1.15–2.00, p=0.003) but not progression-free survival (HR=1.38, 95% CI=0.81–2.35, p=0.238) in patients with SCLC. Moreover, a high SII was associated with extensive-stage SCLC (OR=2.43, 95% CI=1.86–3.17, pConclusionOur meta-analysis demonstrated that a high SII could be an efficient prognostic indicator of OS in SCLC. We recommend adopting SII to predict OS in patients with SCLC, and SII in combination with other parameters or biomarkers may aid in addressing the clinical strategy and choosing the best treatment for an individual patient.

Background: Systemic immune-inflammation index (SII)—comprising platelet, neutrophil, and lymphocyte count—is an objective and reliable biomarker for predicting the prognosis in cancer patients because it comprehensively reflects the balance between host inflammatory and immune responses. In this study, we clarified the prognostic impact of immunoinflammation-based indices, i. e. SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR), in gastric cancer patients. Results: In multivariate analysis, the American Society of Anesthesiologists physical status (ASA-PS) (hazard ratio [HR]: 3.366, p < 0.001), tumor differentiation (HR: 1.705, p = 0.020), pathological Tumor, Node, Metastasis (pTNM) stage (HR: 2.160, p = 0.008), and carcinoembryonic antigen (CEA) (HR: 1.964, p = 0.003) were independent prognostic factors for OS in all patients. Further, multivariate analysis revealed that age (HR: 2.088, p = 0.040), ASA-PS (HR: 2.339, p = 0.043), tumor differentiation (HR: 1.748, p = 0.044), and pTNM stage (HR: 2.114, p = 0.024) were independent prognostic factors for OS among patients without inflammation; SII was not a prognostic factor for OS. Meanwhile, body mass index (HR: 5.055, p = 0.011), ASA-PS (HR: 3.403, p = 0.007), and SII (HR: 4.208, p = 0.026) were independent prognostic factors for OS among patients with inflammation. Materials and Methods: We performed a retrospective review of 412 patients who underwent curative laparoscopic gastrectomy. The prognostic value of SII was compared between a low SII group (SII

Inflammation indicators, such as systemic inflammation response index (SIRI), systemic immune‐inflammation index (SII), neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR), are associated with poor prognosis in various solid cancers. In this study, we investigated the predictive value of these inflammation indicators in nasopharyngeal carcinoma (NPC). This retrospective study involved 559 patients with NPC and 500 patients with chronic rhinitis, and 255 NPC patients were followed up successfully. Continuous variables and qualitative variables were measured by t test and chi‐square test, respectively. The optimal cut‐off values of various inflammation indicators were determined by receiver operating characteristic (ROC) curve. Moreover, the diagnostic value for NPC was decided by the area under the curves (AUCs). The Kaplan‐Meier methods and the log‐rank test were used to analyse overall survival (OS) and disease‐free survival (DFS). The independent prognostic risk factors for survival and influencing factors of side effects after treatment were analysed by Cox and logistic regression analysis, respectively. Most haematological indexes of NPC and rhinitis were significantly different between the two groups, and PLR was optimal predictive indicators of diagnosis. In the multivariable Cox regression analysis, PLR, WBC, RDW, M stage and age were independent prognostic risk factors. Many inflammation indicators that affected various side effects were evaluated by logistic regression analysis. In conclusion, the combined inflammation indicators were superior to single haematological indicator in the diagnosis and prognosis of NPC. These inflammation indicators can be used to supply the current evaluation system of the TNM staging system to help predict the prognosis in NPC patients.

Background: There is a high prevalence of diabetes mellitus (DM) in patients with pancreatic ductal adenocarcinoma (PDAC). An inflammatory response is considered as a potential mechanism involved in the process. The systemic immune-inflammation (SII) index is an integrated and novel inflammatory indicator developed in recent years. The purpose of this study was to determine the relationship between the SII and DM secondary to PDAC. Method: Patients with a confirmed diagnosis of PDAC were analyzed in this cross-sectional study. Anthropometric measures, glucose-related data (including fasting glucose, 2 h OGTT, glycated hemoglobin, fasting insulin, and fasting c-peptide), tumor characteristics (tumor volumes, location and stages), and the periphery blood inflammatory index (white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII) were recorded. The inflammation index was analyzed for its association with glucose-related parameters. Multivariable logistic regression analysis was used to analyze the association between SII levels and DM secondary to PDAC. Results: Blood cell results showed that the white blood cell count, neutrophils, lymphocytes, monocytes, platelets, the neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were higher in patients with diabetes. It was worth noting that SII significantly increased in patients with diabetes secondary to PDAC (4.41 vs. 3.19, p < 0.0001). Multivariable logistic regression analysis showed that SII (OR: 2.024, 95%CI: 1.297, 3.157, p = 0.002) and age (OR: 1.043, 95%CI: 1.01, 1.077, p = 0.011) were the risk factors for DM secondary to PDAC after adjusting for covariates. According to Spearmen correlation analysis, SII was positively correlated with fasting glucose (r = 0.345, p < 0.0001), 2 h OGTT (r = 0.383, p < 0.0001), HbA1c (r = 0.211, p = 0.005), fasting insulin (r = 0.435, p < 0.0001), fasting C-peptide (r = 0.420, p < 0.0001), and HOMA2-IR (r = 0.491, p < 0.0001). Conclusions: In conclusion, SII is significantly increased among patients with DM secondary to PDAC and is associated with the DM in patients with PDAC (OR: 2.382, 95% CI: 1.157, 4.903, p = 0.019). Additionally, SII is significantly correlated with insulin resistance. We are the first to investigate the relationship between SII and diabetes secondary to PDAC and further confirm the role of an inflammatory response in this process. More studies need to be designed to clarify how inflammatory responses participate.

Background: The progression and metastasis of cancers are associated with systematic immune inflammation and nutritional dysfunction. The systemic immune-inflammation index and prognostic nutritional index (PNI) have shown a prognostic impact in several malignancies. Therefore, our study aimed to evaluate immune inflammation and nutritional index prognostic significance in patients with medulloblastoma (MB).Methods: We retrospectively analyzed 111 patients with MB between 2001 and 2021 at our institution. The optimal cutoff values for systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte counts ration (MLR), and PNI were evaluated with receiver operating characteristic (ROC) curve analysis. Clinical characteristics and SII, NLR, MLR, and PNI were tested with the Pearson's chi-squared test. The Kaplan–Meier survival curves and the Cox proportional hazards model were used to evaluate the effects of immune inflammation and nutritional index on overall survival (OS).Results: Receiver operating characteristic curve analysis determined the optimal SII, NLR, MLR, and PNI cutoff values of 2,278, 14.83, 0.219, and 56.5 that significantly interacts with OS and divided the patients into two groups. Comparative survival analysis exhibited that the high-SII cohort had significantly shorter OS (p = 0.0048) than the low-SII cohort. For the univariate analysis, the results revealed that preoperative hydrocephalus (p = 0.01), SII (p = 0.006), albumin–bilirubin score (ALBI) (p = 0.04), and coSII–PNI were predictors of OS. In the multivariate analysis, preoperative hydrocephalus (p < 0.001), ALBI (p = 0.010), SII (p < 0.001), and coSII–PNI as independent prognostic factors were significantly correlated with OS.Conclusion: The preoperative SII, ALBI, and coSII–PNI serve as robust prognostic biomarkers for patients with MB undergoing surgical resection.

ObjectivesVarious blood inflammatory biomarkers were associated with treatment response and prognosis of non-small cell lung cancer (NSCLC) in previous studies. In this study, we retrospectively evaluated the prognostic role of pretreatment blood inflammatory biomarkers and epidermal growth factor receptor (EGFR) mutation status in stage IIIA/N2 NSCLC patients with trimodality therapy.MethodsCompletely resected stage IIIA/N2 NSCLC patients with adjuvant chemotherapy and postoperative radiotherapy (PORT) were assessed in this study. Cutoff values of blood inflammatory factors were calculated by the R package SurvivalROC of R software. SPSS Statistics software was used for survival analyses. Kaplan-Meier survival curve and log-rank test were used to compare the survival difference between every two groups. Univariate and multivariate analyses of predictive factors were performed by Cox proportional hazards regression model.ResultsThe univariate analysis showed that T stage (p=0.007), EGFR mutation status (p=0.043), lymphocyte-to-monocyte ratio (LMR) (p=0.067), and systemic immune-inflammation index (SII) (p=0.043) were significant prognostic factors of disease-free survival (DFS). In the multivariate analysis, T2 (HR=0. 885, 95% CI: 0.059-0.583, p=0.004), EGFR mutation-positive (HR=0.108, 95% CI: 0.023-0.498, p=0.004) and elevated pretreatment SII (HR=0.181, 95%CI: 0.046-0.709, p=0.014) were independently related to shorter DFS. High pretreatment neutrophil counts (HR=0.113, p=0.019) and high systemic inflammation response index (SIRI) (HR=0.123, p=0.025) were correlated with worse overall survival (OS) by the univariate analysis. In the multivariate analysis, only high pretreatment SIRI was an independent predictor for poorer OS (HR=0.025, 95% CI: 0.001-0.467, p=0.014).ConclusionsIn conclusion, we identified that high pretreatment SII and SIRI were unfavorable prognostic factors in stage IIIA/N2 NSCLC patients treated with surgery, adjuvant chemotherapy and PORT. Patients with high pretreatment SII, high pretreatment SIRI, T2, and EGFR mutation-positive may need more forceful adjuvant treatment. Further prospective studies with large-scale are needed to validate our results and identify the proper cut-off values and optimum adjuvant treatment for distinct patient population.

Background: The aim of this study was to investigate how the systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), taken individually and combined, are associated with overall survival (OS) in patients surgically treated for malignant salivary gland tumors (MSGTs). Methods: A retrospective analysis of 74 cases following surgery at our department between January 2011 and June 2018 was performed. The Receiver Operating Characteristic (ROC) curve was used to calculate the optimal cutoff values for SII, SIRI, PLR, and NLR. Survival curves of different groups at 1–3–5 years were estimated using the Kaplan–Meier method. Results: The optimal thresholds with the highest sensitivity and specificity were 3.95 for NLR, 187.6 for PLR, 917.585 for SII, and 2.045 for SIRI. The ROC curves revealed that the best combination with AUC = 0.884 was SII + SIRI. The estimated 5-year OS probability in patients with SII+ SIRI scores of 0, 1, and 2 was 96%, 87.5% and 12.5%, respectively (p < 0.001). Conclusion: SII+ SIRI can independently predict the OS of patients after MSGT surgery. The prognostic score system based on SII+ SIRI may be good clinical practice as a reference for clinical decision-making.

Coronavirus disease 2019 (COVID-19) triggers important changes in routine blood tests. In this retrospective case-control study, biochemical, hematological and inflammatory biomarkers between March 10, 2020, and November 30, 2020 from 3969 COVID-19 patients (3746 in the non-intensive care unit (non-ICU) group and 223 in the ICU group) were analyzed by dividing into three groups as spring, summer and autumn. In the non-ICU group, lymphocyte to monocyte ratio was lower in autumn than the other two seasons and neutrophil to lymphocyte ratio was higher in autumn than the other two seasons. Also, monocyte and platelet were higher in spring than autumn; and eosinophil, hematocrit, hemoglobin, lymphocyte, and red blood cells decreased from spring to autumn. In the non-ICU group, alanine aminotransferase and gamma-glutamyltransferase gradually increased from spring to autumn, while albumin, alkaline phosphatase, calcium, total bilirubin and total protein gradually decreased. Additionally, C-reactive protein was higher in autumn than the other seasons, erythrocyte sedimentation rate was higher in autumn than summer. The changes in routine blood biomarkers in COVID-19 varied from the emergence of the disease until now. Also, the timely changes of blood biomarkers were mostly more negative, indicating that the disease progresses severely. The study was approved by the Erzincan Binali Yildirim University Non-interventional Clinical Trials Ethic Committee (approval No. 86041) on June 21, 2021.

Background:Systemic immune-inflammation index (SII) is a novel biomarker that reflects the state of a patient's inflammatory and immune status. This study aimed to determine the clinical significance of SII as a predictor of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH).Methods:Retrospective data were collected from aneurysmal SAH patients who had been admitted to our hospital between January 2015 and October 2019. Both univariate and multivariate analyses were performed to investigate whether SII was an independent predictor of DCI. In addition, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were also evaluated.Results:There were 333 patients with aneurysmal SAH included in this study. Multivariate logistic analysis revealed that a modified Fisher grade 3 and 4 score [odds ratio (OR) = 7.851, 95% confidence interval (CI): 2.312–26.661,P= 0.001] and elevated SII (OR = 1.001, 95% CI: 1.001–1.002,P< 0.001) were independent risk factors for DCI. ROC curves showed that SII could predict DCI with an AUC of 0.860 (95% CI: 0.818–0.896,P< 0.001). The optimal cut-off value for SII to predict DCI was 1,424, and an SII ≥ 1,424 could predict DCI with a sensitivity of 93.1% and a specificity of 68.1%. Patients with higher SII value on admission tended to have higher incidence of acute hydrocephalus and DCI, greater modified Fisher and Hunt-Hess scales, and poorer outcomes.Conclusions:SII is an independent predictor of DCI in patients with aneurysmal SAH. The SII system can be implemented in a routine clinical setting to help clinicians diagnose patients with high risk of DCI.

Weipeng Shi,1,2 Yingzhen Wang,1 Xuan Zhao,3 Tengbo Yu,1 Tao Li1 1Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, People’s Republic of China; 2Medical Department of Qingdao University, Qingdao, Shandong, 266071, People’s Republic of China; 3Department of Rheumatism and Immunology, The Affiliated Hospital of Jining Medical University, Jining, 272007, People’s Republic of ChinaCorrespondence: Tao Li; Tengbo YuDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of ChinaEmail litaodoctor@sina.com; ytb1970@126.comPurpose: In the present study, we aimed to identify more effective biomarkers for the diagnosis of periprosthetic joint infection (PJI) by comparing the diagnostic ability of C-reactive protein (CRP)/albumin, systemic immune-inflammation index (SII), and existing biomarkers.Methods: In this single-center retrospective analysis, 216 patients who underwent revision knee or hip arthroplasty from June 2013 to June 2021 and met the inclusion and exclusion criteria were analyzed, including 80 patients in the PJI group and 136 patients in the non-PJI group. The following information was collected for analysis, including CRP, fibrinogen, erythrocyte sedimentation rate (ESR), D-dimer, platelet count (PC), neutrophil count (N), lymphocyte count (Lym), and albumin count on the second day of admission. The receiver operating characteristic (ROC) curve was used to compare the diagnostic ability of various biomarkers, and further subgroup analysis was carried out in the PJI group.Results: Compared with the non-PJI group, CRP, fibrinogen, D-dimer, ESR, CRP/albumin, and SII in the PJI group were significantly increased (P < 0.001), and their area under the curve (AUC) was 0.937, 0.878, 0.777, 0.914, 0.941, and 0.765, respectively. In the three subgroup analyses, there was no significant difference in appeal biomarker (P > 0.05) based on PJI culture results, infection time, and infection site.Conclusion: CRP/albumin had a promising prospect as a new biomarker for the diagnosis of PJI, while it had insufficient predictive ability in the PJI subgroup analysis. However, SII had insufficient ability to diagnose PJI. Therefore, SII was not suitable to be used as a diagnostic biomarker.Keywords: periprosthetic joint infection, CRP/albumin, systemic immune-inflammation index, biomarker

Background: The prediction of intravenous immunoglobulin (IVIG) resistance and cardiovascular complications are critically clinical issues in Kawasaki disease (KD). This prospective study firstly aimed to determine the predictive ability of the systemic immune inflammation index (SII) for IVIG resistance and cardiovascular complications and compare the prognostic accuracy of SII with that of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR).Methods: Patients with KD were divided into different groups according to the presence of IVIG resistance or cardiovascular complications (coronary artery lesions, valve regurgitation, myocarditis, pericardial effusion, and Kawasaki disease shock syndrome [KDSS]). The clinical and laboratory parameters were compared. Further analysis stratified by platelet level was performed. Multivariate logistic regression analysis was used to identify predictors for IVIG resistance and cardiovascular complications. The receiver operating characteristic (ROC) curve was applied to assess and compare the ability of SII, NLR, and PLR for predicting IVIG resistance and cardiovascular complications.Results: SII was significantly higher in KD patients with IVIG-resistance, myocarditis, valve regurgitation, and KDSS. It was identified as an independent risk factor for IVIG resistance, myocarditis, and valve regurgitation. For KD patients with thrombocytopenia, there were no significant differences in SII between KD patients with IVIG resistance/cardiovascular complications and those without. The best cutoff values of SII for IVIG resistance, myocarditis, valve regurgitation, and KDSS prediction in the whole cohort were 1331.4 × 109, 1368.6 × 109, 1002.4 × 109, and 1485.4 × 109, with a corresponding sensitivity of 0.525, 0.614, 0.754, and 0.670, a specificity of 0.711, 0.723, 0.584, and 0.730, respectively. The predictive value of SII for both IVIG resistance and cardiovascular complications were not superior to that of NLR.Conclusion: Although the parameter of SII may predict IVIG resistance, myocarditis, valve regurgitation, and KDSS in KD as a single parameter, its predictive ability was not good enough and not superior to NLR. SII might not be applicable in patients with KD having thrombocytopenia.

Background The systemic immune-inflammation index (SII) has been demonstrated to be a valid biomarker of a patient's immunological and inflammatory state, with the ability to accurately predict outcomes in a variety of disease conditions. In the absence of comparable studies, we intended to examine the relevance of pretreatment SII in predicting the success rates of temporomandibular joint arthrocentesis (TMJA) at 1-week, 1-month, and 6-month periods, defined as maximum mouth opening (MMO) > 35 mm and VAS ≤ 3. Methods A sum of 136 patients with disc displacement without reduction (DDwo-red) who underwent TMJA was included. For each patient, pre-TMJA SII was calculated as; SII = Platelets × neutrophils/lymphocytes. Additionally, baseline MMO and VAS measurements were recorded for each patient. The success criteria of TMJA included MMO > 35 mm and VAS ≤ 3. The optimal pre-TMJA SII cutoff that predicts TMJA success was determined using receiver operating characteristic (ROC) curve analysis. The primary endpoint was the link between the pre-treatment SII and TMJA success (simultaneous achievement of MMO > 35 mm and VAS ≤ 3). Results The median pre-TMJA jaw locking duration, maximum mouth opening (MMO), and visual analog score (VAS) were 7 days, 24 mm, and 8, respectively. The overall TMJA success rates were determined as 80.1%, 91.9%, and 69.1% at 1-week, 1-month, and 6-months, respectively. The results of ROC curve analysis exhibited the optimal SII cutoff at 526 (AUC: 67.4%; sensitivity: 66.7%; specificity: 64.2%) that grouped the patients into two subgroups: Group 1: SII ≤ 526 (N = 81) and SII > 526 (N = 55), respectively. Spearman correlation analysis revealed a strong inverse relationship between the pretreatment SII values and the success of TMJA 1-week (rs: − 0.83; P = 0.008) and 1-month, (rs: − 0.89; P = 0.03). Comparative analyses displayed that TMJA success rates at 1-week (87.7% vs. 69.1%; P = 0.008) and 1-month (96.2% vs. 80%; P = 0.03) were significantly higher in the SII ≤ 526 than SII > 526 group, respectively, while the 6-month results favored the SII ≤ 526 group with a trend approaching significance (P = 0.084). Conclusion The current study's findings suggested the SII as a unique independent prognostic biomarker that accurately predicts treatment outcomes for up to 6 months. Trial registration The results of this research were retrospectively registered.

Background: Induction chemotherapy (IC) was associated with a decreased risk of distant metastasis in locally advanced nasopharyngeal carcinoma (LA-NPC). However, compared with TPF, whether the TP regimen can reduce the related toxicities caused by 5-FU while ensuring the survival benefit remains unclear.Methods: 213 patients diagnosed with LA-NPC (stage III-IVA) were included retrospectively. The prognosis of TPF and TP was compared by Kaplan-Meier and Cox proportional hazard regression. The treatment-related toxicities were evaluated according to CTCAE v4.0 and RTOG criteria. Results: TPF was found to have a higher 5-year DMFS in stage IVA and N2-3 patients, which not applicable to stage III and N0-1. The optimal value of pre-treatment SII was 432.48. A further subgroup analysis revealed that patients in stage IVA combined with pretreatment SII≥432.48 could get higher OS (P=0.038) and DMFS (P=0.028) from TPF. Multivariate analysis showed that SII was a prognostic factor for PFS (HR 2.801, P=0.018) and DMFS (HR 3.735, P=0.032), and IC regimen (HR 2.182, P=0.049) for predicting DMFS. The rate of grade 3-4 leukopenia (P=0.038), neutropenia (P=0.021), radiation oral mucositis (P=0.048) and diarrhea (P=0.036) were more common in TPF group. Conclusion: Our study revealed that TPF regimen showed a higher 5-year DMFS for stage IVA and N2-3 patients, while TP may be enough for stage III and N0-1. In LA-NPC patients with high risk (stage IVA combined with pre-treatment SII ≥ 432.48), TPF had a higher 5-year OS and DMFS, although grade 3-4 toxicities were more common but tolerable.

ObjectiveThe systemic immune-inflammation index (SII) based on neutrophil, platelet and lymphocyte counts, is a prognostic biomarker in some solid cancers. However, the prognostic value of SII has not yet been validated. This study was to evaluate the role of SII in predicting survival for patients with diffuse large B cell lymphoma (DLBCL).MethodsWe retrospectively investigated 224 patients with DLBCL between August 2005 and October 2018. Kaplan–Meier analysis and Cox proportional hazard models were used to assess the prognostic value of SII.ResultsIn the ROC curve analysis, SII had the highest AUC and was more accurate as a prognostic factor. Patients with higher SII tended to have higher level of LDH, more advanced stage, poor PS, and high IPI score compared with low SII group. In univariate analyses, SII, PLR and NLR were all prognostic for progression-free survival and overall survival. Moreover, only SII, older age, HBSAg-positive and IPI were the independent prognostic factors for patients in multivariate analysis. The nomogram based on SII, older age, HBSAg status and IPI showed accurate prognostic ability for predicting 3-years and 5-years survival rates (c-index, 0.791) compared to the IPI alone (c-index, 0.716).ConclusionSII was a powerful tool for predicting outcome in patients with DLBCL. It might assist the separation of high-risk patients among patients with the same IPI.

Background The systemic immune-inflammation index (SII) is correlated with patient survival in various types of solid tumors. However, only a few studies have focused on the prognostic value of the SII in patients with surgically resected non-small cell lung cancer (NSCLC). Methods This study was a single center retrospective analysis of 569 NSCLC patients who underwent curative lobectomy at the Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2006 and 2012. A receiver operating characteristic curve was plotted to compare the discriminatory ability of the SII for overall survival (OS). A Cox proportional hazards regression model was used to perform univariate and multivariate analyses. Results The SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) all correlated with OS in NSCLC patients, and the SII was an independent prognostic factor for OS (hazard ratio 1.256, 95% confidence interval 1.018-1.551; P = 0.034). The area under the receiver operating characteristic curve of the SII (0.547) was larger than the NLR (0.541) and PLR (0.531). Furthermore, the SII retained prognostic significance in the lung adenocarcinoma subgroup. Conclusion The SII is a promising prognostic predictor for patients with surgically resected NSCLC and retained prognostic significance in the lung adenocarcinoma subgroup. The prognostic value of the SII is superior to the NLR and PLR.

The tumor microenvironment (TME) and the host inflammatory response are closely interconnected. The interplay between systemic inflammation and the local immune response may influence tumor development and progression in various types of cancer. The systemic immune–inflammation index (SII) represents a prognostic marker for germ cell tumors (GCTs). The aim of the present study was to detect specific immune cell subpopulation changes which were associated with the SII level in chemotherapy-naïve GCT patients. In total, 51 GCT patients, prior to cisplatin-based chemotherapy, were included in the present study. Immunophenotyping of peripheral blood leukocyte subpopulations was performed using flow cytometry. The SII level was correlated with the percentage of various leukocyte subpopulations. The obtained results demonstrated that SII levels above the cut-off value of SII ≥ 1003 were associated with higher neutrophil percentages. An inverse correlation was found between the SII and the peripheral lymphocyte percentage that logically reflects the calculations of the SII index. Furthermore, the presented data also showed that in the lymphocyte subpopulation, the association with the SII was driven by T-cell subpopulations. In innate immunity–cell subpopulations, we observed a correlation between SII level and neutrophils as well as associations with eosinophil, basophil, natural killer cell and dendritic cell percentages. We suppose that the described interactions represent a manifestation of cancer-induced immune suppression. The results of the present study contribute to the elucidation of the interrelationship between tumor cells and the innate/adaptive immune system of the host.

Background Recently, studies on COVID-19 have focused on the epidemiology of the disease and clinical characteristics of patients, as well as on the risk factors associated with mortality during hospitalization in critical COVID-19 cases. However, few research has been performed on the prediction of disease progression in particular group of patients in the early stages of COVID-19. Methods The study included 338 patients with COVID-19 treated at two hospitals in Wuhan, China, from December 2019 to March 2020. Predictors of the progression of COVID-19 from mild to severe stages were selected by the logistic regression analysis. Results COVID-19 progression to severe and critical stages was confirmed in 78 (23.1%) patients. The average value of the neutrophil-to-lymphocyte ratio (NLR) was higher in patients in the disease progression group than in the improvement group. Multivariable logistic regression analysis revealed that elevated NLR, LDH and IL-10 were independent predictors of disease progression. The optimal cut-off value of NLR was 3.75. The values of the area under the curve, reflecting the accuracy of predicting COVID-19 progression by NLR was 0.739 (95%CI: 0.605–0.804). The risk model based on NLR, LDH and IL-10 had the highest area under the ROC curve. Conclusions The performed analysis demonstrates that high concentrations of NLR, LDH and IL-10 were independent risk factors for predicting disease progression in patients at the early stage of COVID-19. The risk model combined with NLR, LDH and IL-10 improved the accuracy of the prediction of disease progression in patients in the early stages of COVID-19.

Jingjie Hu,&ast; Liuyuan Wang,&ast; Kaili Fan, Wenwei Ren, Qiongzhang Wang, Yiting Ruan, Chengxiang Yuan, Guiqian Huang, Jincai He Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jincai He; Guiqian HuangDepartment of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, People’s Republic of ChinaTel +86 577-555780166; +86 577-555781380Fax +86 577-55578033; +86 577-55578999Email hjc@wmu.edu.cn; huangguiqian123@126.comObjective: Inflammation plays an important role in stroke. Many inflammatory markers in peripheral blood are proved to be associated with stroke severity or prognosis. But few comprehensive models or scales to evaluate the post-stroke depression (PSD) have been reported. In this study, we aimed to compare the level of systemic inflammation markers between PSD and non-PSD patients and explore the association of these inflammatory markers with PSD.Methods: Totally, 432 ischemic stroke patients were consecutively enrolled in the study and received 1 month follow-up. We used the 17-Hamilton Rating Scale to measure depressive symptoms at 1 month after stroke. With the Hamilton Depression Scale score of > 7, patients were diagnosed with PSD. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated from the admission blood work.Results: Finally, 129 patients (30.5%) were diagnosed with PSD at 1 month. PSD patients showed significantly higher levels of SII (501.27 (345.43– 782.58) vs 429.60 (315.64– 570.98), P=0.001), NLR (2.36 (1.77– 3.82) vs 2.17 (1.56– 2.80), P=0.010), dNLR (1.67 (1.30– 2.51) vs 1.54 (1.16– 1.99), P=0.009), PLR (124.65 (95.25– 155.15) vs 109.22 (92.38– 142.03), P=0.015), especially SII at admission as compared to non-PSD patients. In the logistic analysis, SII value (> 547.30) was independently associated with the occurrence of PSD (OR=2.181, 95% CI=1.274– 3.732, p =0.004), better than dNLR (OR=1.833, 95% CI=1.071– 3.137, p =0.027), PLR (OR= 1.822, 95% CI=1.063– 3.122, p =0.029) and NLR (OR =1.728, 95% CI=1.009– 2.958, p =0.046).Conclusion: Increased SII, PLR, dNLR, NLR, particularly SII at admission, are significantly correlated with PSD and may add some prognostic clues to find early discovery of PSD.Keywords: inflammatory markers, post-stroke depression, systemic immune-inflammation index, neutrophil-to-lymphocyte, platelet-to-lymphocyte, derived neutrophil-to-lymphocyte ratio

BackgroundPrevious studies have investigated the role of systemic immune-inflammation index (SII) as a prognostic factor for gastric cancer (GC) patients, although with inconsistent results. Thus, the aim of this study was to identify the prognostic value of SII in GC through meta-analysis.MethodsWe systematically searched the PubMed, Embase, and Web of Science databases for relevant studies investigating the prognostic role of SII in GC up to December 2019. The hazard ratios (HRs) and 95% confidence intervals (CIs) related to overall survival (OS) and disease-free survival (DFS) were combined. Odds ratios (ORs) and 95% CIs were pooled to assess the correlation between SII and clinicopathological features of GC.ResultsA total of eight studies, comprising 4,236 patients, were included in this meta-analysis. Pooled analysis indicated that a high pretreatment SII predicted poor OS (HR=1.40, 95% CI=1.08–1.81, p=0.010) but not poor DFS (HR=1.30, 95% CI=0.92–1.83, p=0.140) in GC. In addition, an elevated SII correlated with an advanced tumor–node–metastasis stage (OR=2.34, 95% CI=1.40–3.92, p=0.001), T3–T4 stage (OR=2.25, 95% CI=1.34–3.77, p=0.002), positive lymph node metastasis (OR=1.79, 95% CI=1.12–2.87, p=0.016), and tumor size ≥ 5 cm (OR=2.28, 95% CI=1.62–3.22, pConclusionsA high pretreatment SII significantly associated with poorer survival outcomes as well as several clinical characteristics in GC. We suggest that SII could be monitored to guide prognostication and provide reliable information on the risk of disease progression in GC.

Background The systemic immune-inflammation index (SII), based on peripheral platelet, neutrophil and lymphocyte counts, has been proven to be a promising prognostic indicator in various diseases. Hip fracture is a common injury among the older adults, and has become a global public health problem with high mortality and disability rates. However, the relationship between SII and the prognosis of hip fracture is not yet well-known. The aim of the this study was to explore the predictive value of SII in older adults with hip fracture undergoing surgery. Methods This was a prospective cohort study performed from January 2014 to December 2018 at a orthopaedic center, China. The SII was calculated as platelet×neutrophil/lymphocyte counts. Univariable and multivariable Cox proportional hazard models were used to assess the association between SII and all-cause mortality. Results A total of 290 older adults with hip fracture were included, and the mean (SD) age was 77.6 (8.6) years, and 189 (65.2%) were female. The median (IQR) SII was 759.4 (519.0–1128.7) × 109/L. After a median follow-up time of 33.4 months, 13 (4.5%), 26 (9.0%) and 54 (18.6%) patients died within the 30-day, 1-year and last follow-up, respectively. Multivariable Cox analysis revealed that each increase of 100 units of SII was associated with a 8% increased hazard of death at 1-year follow-up (HR = 1.08, 95% CI: 1.01–1.17, p = 0.033), and 9% increased hazard of death at last follow-up (HR = 1.09, 95% CI: 1.03–1.15, p = 0.003). Conclusions SII is associated with poor all-cause mortality in older adults with hip fracture undergoing surgery, and deserves further investigation and application in clinical practice.

Purpose To investigate the prognostic role of the preoperative systemic immune–inflammation index (SII) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and methods We retrospectively analyzed our multi-institutional database to identify 2492 patients. SII was calculated as platelet count × neutrophil/lymphocyte count and evaluated at a cutoff of 485. Logistic regression analyses were performed to investigate the association of SII with muscle-invasive and non-organ-confined (NOC) disease. Cox regression analyses were performed to investigate the association of SII with recurrence-free, cancer-specific, and overall survival (RFS/CSS/OS). Results Overall, 986 (41.6%) patients had an SII > 485. On univariable logistic regression analyses, SII > 485 was associated with a higher risk of muscle-invasive (P = 0.004) and NOC (P = 0.03) disease at RNU. On multivariable logistic regression, SII remained independently associated with muscle-invasive disease (P = 0.01). On univariable Cox regression analyses, SII > 485 was associated with shorter RFS (P = 0.002), CSS (P = 0.002) and OS (P = 0.004). On multivariable Cox regression analyses SII remained independently associated with survival outcomes (all P P = 0.02). However, all area under the curve and C-indexes increased by Conclusions Preoperative altered SII is significantly associated with higher pathologic stages and worse survival outcomes in patients treated with RNU for UTUC. However, the SII appears to have relatively limited incremental additive value in clinical use. Further study of SII in prognosticating UTUC is warranted before routine use in clinical algorithms.

Background: The systemic immune-inflammation index (SII) and Epstein-Barr virus DNA (EBV DNA) levels has been used as a prognostic marker for nasopharyngeal carcinoma (NPC) patients, but there is no in-depth study in locally advanced NPC patients and no research on the predictive value of their combination. Our study aimed to evaluate the prognostic efficacy of the pretreatment SII, EBV DNA levels and their combination in locally advanced NPC patients receiving induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT). Materials and methods: 319 patients diagnosed with locally advanced NPC receiving IC followed by CCRT were retrospectively reviewed (213 in the training cohort and 106 in the validation cohort). The cut-off value for the SII was determined using receiver operating characteristic (ROC) curve. Correlations between characteristics of patients were assessed using the Pearson correlation coefficient. Survival curves for the SII, EBV DNA levels and their combination were analyzed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed by the Cox proportional hazards regression model to evaluate the prognostic impact on overall survival (OS) and progression-free survival (PFS). A prognostic nomogram was generated and its prediction ability was measured by the concordance index (C-index). Results: The optimal cutoff point for the SII was 402.10. A higher SII and EBV DNA positivity were demonstrated to be related to poorer survival outcomes (P < 0.05). Multivariate analyses showed that a higher SII, EBV DNA positivity and their combination were powerful independent risk factors for OS and PFS (P < 0.05). The SII - EBV DNA had the largest area under the curve (AUC) compared to either score alone. The incorporation of the SII - EBV DNA into established nomogram achieved higher C-index in the prediction of OS and PFS, indicating its superior for predicting survival. All results were found in the training cohort and confirmed in the validation cohort. Conclusions: The pretreatment SII and EBV DNA levels are promising factors for predicting survival in locally advanced NPC patients. The combination of them, which was superior to either score alone, was a complement to the conventional TNM staging system.

Purpose: To evaluate diagnostic and predictive values of the serum vascular endothelial growth factor-A (VEGF-A) level and systemic immune-inflammation index (SII) in small cell lung cancer (SCLC) patients. Methods: From January 2018 to April 2020, we prospectively enrolled 59 untreated SCLC patients in the study group and 50 non-neoplastic patients in the control group. Blood samples were collected at baseline, after the first two cycles of chemotherapy and at progression in the study group and at entry in the control group. Serum VEGF-A was measured by chemiluminescence, SII was calculated based on complete blood count results, and the relationship between the VEGF-A/SII and clinicopathological characteristics, chemotherapeutic efficacy and progression-free survival (PFS) of SCLC patients was analyzed. Results: Baseline serum VEGF-A was significantly higher in SCLC patients than in non-neoplastic patients (P0.050). Univariate and multivariate Cox regression analyses suggested that baseline VEGF-A (HR: 3.443, 95% CI: 1.330-8.908, P=0.011) was an independent prognostic factor for PFS in SCLC patients. Conclusions: Baseline serum VEGF-A and SII are associated with important clinicopathological characteristics of SCLC patients. VEGF-A, but not SII, has the ability of diagnosis and predicting first-line chemotherapeutic efficacy and prognosis in SCLC patients.

Background Systemic immune-inflammation index (SII) has been suggested to be effective to reflect the inflammatory status and thus may be an underlying biomarker for prognosis prediction. This hypothesis has been demonstrated in meta-analyses on several cancer types. However, there was no study to confirm the prognostic roles of SII for gynecological and breast cancers, which was the goal of our study. Methods PubMed, EMBASE, and Cochrane Library databases were searched to collect the articles exploring the associations of SII with prognostic outcomes [overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), lymph node metastasis (LNM), and lymphovascular invasion (LVI)] in gynecological and breast cancers. The prognostic value of SII was estimated by hazard ratio (HR) or relative risk (RR) with 95% confidence interval (CI). Results Nine articles involving 2724 patients in 11 datasets were included. Meta-analysis showed that a high SII index was significantly associated with poor OS (HR = 2.12, 95% CI, 1.61–2.79, P < 0.001), DFS/PFS (HR = 2.28, 95% CI 1.52–3.41, P < 0.001) and an increased risk for LNM (RR = 1.34, 95% CI 1.20–1.50, P < 0.001) in patients with gynecological and breast cancers. Subgroup analysis confirmed the prognostic role of SII for OS was applicable to all cancer types, but the association with DFS/PFS and LNM was only significant for ovarian cancer and breast cancer, especially triple-negative breast cancer. No significant association was detected between SII and LVI. Conclusion High SII may be a promising indicator for the prediction of poor prognosis in patients with gynecological and breast cancers, especially ovarian cancer and triple-negative breast cancer.

Introduction Intrahepatic cholangiocarcinoma (ICC) stands as the second most common malignant tumor in the liver with poor patient prognosis. Increasing evidences have shown that inflammation plays a significant role in tumor progression, angiogenesis, and metastasis. However, the prognosis significance of inflammatory biomarkers on recurrence-free survival (RFS) and overall survival (OS) in ICC patients is poorly recognized. Methods ICC patients who underwent curative hepatectomy and diagnosed pathologically were retrospectively analyzed. Inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII), were investigated. Results Receiver operating characteristic (ROC) curves showed no significance in NLR, PLR, and LMR in RFS and OS, while significant results were shown on SII in both RFS (P = 0.035) and OS (P = 0.034) with areas under ROC curve as 0.63 (95%CI 0.52–0.74) and 0.62 (95%CI 0.51–0.72), respectively. Kaplan-Meier curves revealed a statistically significant better survival data in SII-low groups on both RFS (P < 0.001) and OS (P < 0.001). The univariate and multivariate analyses revealed that higher level of SII was independently associated with both poorer RFS time and OS time. However, no significant result was shown on NLR, PLR, or LMR. Conclusion SII is an effective prognostic factor for predicting the prognosis of ICC patient undergone curative hepatectomy, while NLR, PLR, and LMR are not associated with clinical outcomes of these patients.

Lung cancer is the most common type of cancer worldwide with a high mortality rate. The specific tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR) have made enormous strides in non-small-cell lung cancer (NSCLC) treatment. The novel systemic immune-inflammation index (SII), a parameter that integrates lymphocytes, neutrophils, and platelets, has been found to play the vital role of a marker for predicting survival and recrudescence in various tumors. We retrospectively examined 102 patients with different EGFR-mutant lung adenocarcinomas. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. Cut-off points were identified using the receiver operating characteristic curves with the maximum log-rank values. The Cox proportional hazards regression, expressed as p value, hazards regression, and 95% confidence interval, was conducted to assess the prognostic values of variables in overall survival (OS)/ progression-free survival (PFS). Lower SII was associated with prolonged survival in patients with different EGFR mutant lung adenocarcinomas in both variable and multivariable analyses. SII before treatment was a powerful indicator for the PFS and OS of patients who received the first-generation EGFR-TKI.

Huifeng Bi,1,2 Zhenhua Shang,1 Chunsong Jia,1 Jiangtao Wu,1 Bo Cui,1 Qi Wang,1 Tongwen Ou1 1Department of Urology, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 2Department of Urology, Jincheng General Hospital, Jincheng, Shanxi Province, People’s Republic of ChinaCorrespondence: Tongwen OuXuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, People’s Republic of ChinaTel +86 135 0106 5134Fax +86 010 8319 8388Email outongwen1967@126.comPurpose: This study aimed to investigate the associations between the preoperative prognostic nutritional index (PNI), systemic immune-inflammation index (SII) and overall survival (OS) and cancer-specific survival (CSS) in high-risk non-muscle-invasive bladder cancer (NMIBC) patients who received intravesical instillation of Bacillus Calmette-Guerin (BCG) after transurethral resection of bladder tumour (TURBT).Patients and Methods: We retrospectively collected data from 387 high-risk NMIBC patients between January 2004 and December 2014. PNI was calculated as total lymphocyte count (109/L)× 5+albumin concentration (g/L). SII was calculated as neutrophil count (109/L)×platelet count (109/L)/lymphocyte count (109/L). The cutoff values of PNI and SII were determined through receiver operating characteristic (ROC) analysis. OS and CSS were estimated by Kaplan–Meier analysis. The Log rank test was used to compare differences between the groups. Univariate and multivariate Cox regression analyses were performed to assess the predictive values of PNI and SII for OS and CSS. Additionally, highest-risk NMIBC patients were also divided into low or high groups according to PNI and SII. The OS and CSS of highest-risk NMIBC patients were estimated using Kaplan-Meier analysis with the Log rank test.Results: The patients were divided into two groups according to the cutoff values of PNI (< 50.17 vs ≥ 50.17) and SII (< 467.76 vs ≥ 467.76). Kaplan–Meier analysis revealed that low PNI and high SII were associated with poorer OS and CSS in high-risk NMIBC patients. Univariate and multivariate Cox regression analyses revealed that PNI and SII were independent predictive factors for OS and CSS. Kaplan–Meier analysis also revealed that low PNI and high SII were related to poorer OS and CSS in highest-risk NMIBC patients.Conclusion: These results suggest that preoperative PNI and SII, based on standard laboratory measurements, may be useful noninvasive, inexpensive and simple tools for predicting the long-term survival of high-risk NMIBC patients who received intravesical instillation of BCG after TURBT.Keywords: prognostic nutritional index, systemic immune-inflammation index, non-muscle-invasive bladder cancer, Bacillus Calmette-Guerin, overall survival, cancer-specific survival

Purpose: It was reported that the novel preoperative systemic immune-inflammation index (SII) can predict survival in cases of many malignant tumors. However, the prognostic significance of preoperative SII in breast cancer remains unclear. The purpose of this study was to investigate the relationship between SII and survival in breast cancer patients.Methods: Breast cancer patients (1,026) who underwent a mastectomy at Sun Yat-sen University Cancer Center were retrospectively studied. The SII was determined using the following formula: neutrophil count × platelet count/lymphocyte count. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value for SII. Propensity score matching (PSM) was applied to develop comparable cohorts of high SII group and low SII group.Results: A total of 1,026 patients were included as the primary cohort, and 894 patients were matched and regarded as the matched cohort. Patients were divided into two groups based on SII value: SII 601.7. In the primary cohort, the 5-years overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS) rates for high SII group and low SII group were (85.6% vs. 91.3%, P = 0.016), (95.8% vs. 96.4%, P = 0.684), and (83.5% vs. 90.6%, P = 0.007), respectively. Univariate analysis showed that histological type, T stage, N stage, PR, HER2, Ki67, and SII all showed significant associations with OS; and histological type, T stage, N stage, and SII all showed significant associations with DMFS. Multivariate survival analysis revealed that SII can independently predict OS (P = 0.017) and DMFS (P = 0.007). Similar results were found in PSM cohort.Conclusions: Preoperative SII may be a reliable predictor of OS and DMFS in patients with operable breast cancer to provide personalized prognostication and assist in formulation of the clinical treatment strategy.

Background:Previous studies on the systemic immune-inflammation index (SII), which is based on platelet, neutrophil and lymphocyte counts, as a prognostic marker in patients with colorectal cancer (CRC) yielded inconsistent results. The aim of this study was to evaluate the prognostic and clinicopathological role of SII in CRC via meta-analysis.Methods:A comprehensive literature survey was performed on PubMed, Web of Science, Embase and the Cochrane Library databases to include studies published up to 6 April 2020. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were computed to estimate the prognostic and clinicopathological value of SII in CRC.Results:A total of 12 studies published between 2016 and 2019 were included in our meta-analysis. The combined analysis showed that high SII levels were significantly associated with worse overall survival (OS; HR = 1.61, 95% CI = 1.21–2.13, p = 0.001) and progression-free survival (HR = 1.74, 95% CI = 1.26–2.39, p = 0.001) in CRC. Moreover, elevated SII was also correlated with poor tumor differentiation (OR = 1.60, 95% CI = 1.27–2.02, p Conclusion:Our meta-analysis indicated that high SII levels predicted poor prognosis in CRC. In addition, an elevated SII was also associated with clinical factors, implying higher malignancy of the disease.

Background: Both systemic inflammation response and malnutrition are closely related to poor prognosis in patients with certain types of solid tumor. This study investigated the prognostic value of the preoperative combination of systemic immune-inflammation index and prognostic nutritional index (SII-PNI) in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods: The predictive ability of SII-PNI was developed and further validated in a cohort of 525 UTUC patients (253 in the training cohort and 272 in the validation cohort) who received RNU. Results: Survival analysis indicated that a SII ≥672.44 was significantly associated with worse overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) while a PNI ≥47.83 was associated with better survival outcomes (All P-values < 0.05). The combination of simultaneously SII ≥672.44 and PNI

The systemic immune-inflammation index (SII) is an independent prognostic predictor of hepatocellular carcinoma (HCC). The present investigation examined whether an association exists between preoperative SII value and postoperative acute kidney injury (pAKI) in HCC patients. The study included 479 hepatitis B virus (HBV)-associated HCC patients undergoing hepatectomy. The SII was calculated as P × N/L, where P, N, and L represent the counts of platelets, neutrophils, and lymphocytes in routine blood test, respectively. After propensity score matching, logistic regression analysis was used to explore independent predictors of pAKI in HCC patients. pAKI was confirmed in 51 patients (10.8%). The average SII value was higher in patients with pAKI than patients without pAKI. After multivariate logistic regression analysis, SII, history of hypertension, and tumor size, among others, were found to be predictors of pAKI. The optimal threshold value of SII for predicting pAKI was found to be 547.84 × 109/L. Multivariate analysis performed after propensity score matching confirmed that SII ≥ 547.84 × 109/L was an independent predictor of pAKI. The preoperative SII qualifies as a novel, independent predictor of pAKI in HCC patients with HBV infection who underwent hepatectomy.

PubMedID: 31631675 Aim: To evaluate the prognostic significance of neutrophil lymphocyte ratio, prognostic nutritional index, systemic immune-inflammation index (SII) and B2M in Hodgkin Lymphoma (HL). Materials & methods: Neutrophil-lymphocyte ratio, prognostic nutritional index, SII and B2M were analyzed to assess their prognostic value via the Kaplan-Meier method and Cox regression analysis in 122 HL patients, retrospectively. Results: SII was found to have the highest area under curve and the most sensitive and specific among all markers. In univariate analyses, all four parameters were prognostic for overall survival and progression-free survival, in multivariate analyzes only SII was found to be independent factors for both of them. Conclusion: SII can be suggested as a novel independent and better prognostic factor for predicting overall survival and progression-free survival in HL. © 2019 © 2019 Future Medicine Ltd.

EGFR-TKIs have been widely used in the first-line treatment of NSCLC patients harboring EGFR mutations. However, the prognosis indicators are limited. In the present study, the prognostic value of systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were assessed in EGFR-Mutant lung adenocarcinoma patients treated with first-generation EGFR-TKIs. Two hundred three patients were included in this retrospective analysis. SII was calculated as platelet counts × neutrophil counts / lymphocyte counts. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value for SII, NLR, and PLR. Univariate and multivariate survival analysis were performed to identify factors correlated with PFS and OS. Applying cut-offs of ≥1066.935 (SII), ≥4.40 (NLR), and ≥182.595 (PLR), higher NLR was associated with worse Eastern Cooperative Oncology Group performance status (ECOG PS) (P = .006), and higher brain metastasis rate (P = .03), higher PLR was associated with smoking history (P = .037), and worse ECOG PS (P = .001), and higher SII groups were associated with worse ECOG PS (P = .002). In univariate analysis, higher NLR (P

Chronic inflammation has been indicated to be important in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). The systemic immune-inflammation index (SII) is a novel marker of inflammation. The present study was thus performed to explore the association between the SII at diagnosis and inflammatory response and disease activity in Chinese patients with myeloperoxidase (MPO)-AAV. Furthermore, it was evaluated whether the SII is able to predict the progression to end-stage renal disease (ESRD) and patient survival. A total of 190 patients with MPO-AAV were included in the present study. The baseline SII was positively correlated with C-reactive protein (CRP; r=0.274, P

Background Systemic inflammation and immune dysfunction have been proved to be associated with cancer progression and metastasis in various malignancies. The aim of this retrospective study was to evaluate the prognostic significance of pre-treatment systemic immune-inflammation index (SII) in patients with advanced pancreatic cancer. Methods In total, 419 patients diagnosed with advanced pancreatic cancer, between January 2011 and December 2015, were retrospectively enrolled. The SII was developed based on a training set of 197 patients from 2011 to 2013 and validated in an independent cohort of 222 patients from 2014 to 2015. Data on baseline clinicopathologic characteristics; pre-treatment laboratory variables such as absolute neutrophil, lymphocyte, and platelet counts; and carbohydrate antigen 19-9 (CA19-9), total bilirubin (TBIL), albumin (ALB), alkaline phosphatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST) levels were collected. The association between clinicopathologic characteristics and SII was assessed. The overall survival was calculated using the Kaplan–Meier survival curves and compared using the log-rank test. Univariate and multivariate Cox proportional hazard regression models were used to analyze the prognostic value of the SII. Result An optimal cutoff point for the SII of 440 stratified the patients with advanced pancreatic cancer into high (> 440) and low (≤ 440) SII groups in the training cohort. Univariate and multivariate analyses revealed that the SII was an independent predictor for overall survival. The prognostic significance of the SII was confirmed in both normal and elevated CA19-9 levels. Conclusion The baseline SII serves as an independent prognostic marker for patients with advanced pancreatic cancer and can be used in patients with both normal and elevated CA19-9 levels.

Systemic immune-inflammation index (SII), based on lymphocyte (L), neutrophil (N), and platelet (P) counts, was recently developed and reflects comprehensively the balance of host inflammatory and immune status. We explored its prognostic value in localized gastric cancer (GC) after R0 resection and the potential associations with Thymidine phosphorylase (TYMP), which was reported to increase the migration and invasion of gastric cancer cells. A total of 455 GC patients who received D2 gastrectomy were enrolled. Blood samples were obtained within 1 week before surgery to measure SII (SII = P × N/L). TYMP expression was measured on tumor sections by immunohistochemical analysis. Preoperative high SII indicated worse prognosis (HR: 1.799; 95% CI: 1.174-2.757; p = 0.007) in multivariate analysis and was associated with higher pathological TNM stage, deeper local invasion of tumor and lymph node metastasis (all p < 0.001). SII predicted poor overall survival in pathological TNM stage I subgroup also (p < 0.001). Furthermore we found that in high SII group, positive rate of TYMP expression increased (53.7% vs 42.7%, p = 0.046) and TYMP positive patients had higher SII score (median 405.9 vs. 351.9, p = 0.026). SII, as a noninvasive and low cost prognostic marker, may be helpful to identify higher-risk patients after R0 resection, even for stage I GC patients.

Background: The systemic immune-inflammation index (SII) has been reported to be associated with patient survival in various kinds of solid tumors. However, just few studies have focused on its prognostic value in patients with surgically resected esophageal squamous cell carcinoma (ESCC). Materials and Methods: This study was a single-institution, retrospective analysis of 468 ESCC patients who underwent curative esophagectomy at the Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between 2005 and 2008. The receiver operating curve (ROC) was plotted to compare the discrimination ability of the SII and other inflammatory factors for overall survival (OS) and disease-free survival (DFS). Univariate and multivariate analyses were performed based on the Cox proportional hazards regression model. Results: The SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were all associated with OS in ESCC patients. The SII, NLR, and PLR were independent prognostic factors for OS (hazard ratio (HR) = 1.604, 95% confidence interval (CI) 1.247-2.063, P < 0.001; HR = 1.396, 95% CI 1.074-1.815, P = 0.013; HR = 1.370, 95% CI 1.067-1.758, P = 0.013, respectively) and DFS (HR = 1.681, 95% CI 1.307-2.162, P < 0.001; HR = 1.376, 95% CI 1.059-1.788, P = 0.017; HR = 1.398, 95% CI 1.089-1.794, P = 0.009, respectively). The area under the curve (AUC) for SII was bigger than NLR, PLR, and MLR (0.553, 0.540, 0.532, and 0.521, respectively). Conclusion: The SII is a simple and promising prognostic predictor for patients with surgically resected ESCC. The prognostic value of SII is superior to those of the NLR, PLR and MLR. Moreover, the SII retained prognostic significance in stage I-II ESCC subgroup (OS, DFS) and stage III ESCC subgroup (DFS).

Ronald Wihal Oei,1,2,* Lulu Ye,1,2,* Fangfang Kong,1,2 Chengrun Du,1,2 Ruiping Zhai,1,2 Tingting Xu,1,2 Chunying Shen,1,2 Xiaoshen Wang,1,2 Xiayun He,1,2 Lin Kong,1,2 Chaosu Hu,1,2 Hongmei Ying1,2 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China; 2Department of Oncology, Shanghai Medical College, Shanghai, People’s Republic of China *These authors contributed equally to this work Purpose: The aim of this article is to investigate the significance of pretreatment prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and their combination in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT).Materials and methods: A total of 585 patients were included. PNI and SII were calculated within 2 weeks prior to treatment. The optimal cutoff points were determined based on receiver operating characteristics curve analysis. The correlation between variables was analyzed. Kaplan–Meier method and Cox proportional hazards model were performed to evaluate the impact of both indices on overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). Further propensity score matching (PSM) was carried out to minimize the effects of confounders. Results: The optimal cutoff point of 53.0 for PNI and 527.20 for SII were selected. Pearson correlation coefficient showed an inverse correlation between PNI and SII (r = –0.232, P < 0.001). Multivariate analysis demonstrated that pretreatment PNI was an independent prognostic factor for OS (P = 0.047) and DMFS (P = 0.002) while pretreatment SII was an independent prognostic factor for OS (P = 0.003), PFS (P = 0.002), and DMFS (P = 0.002). After PSM, both parameters remained as independent prognosticators of survival. Additional prognostic value was observed in the combined use of PNI and SII.Conclusion: Pretreatment PNI and SII are promising indicators of survival in NPC patients undergoing IMRT. They can be utilized to refine current TNM staging system in predicting prognosis and developing an individualized treatment in these patients. Keywords: prognostic nutritional index, systemic immune-inflammation index, nasopharyngeal carcinoma, intensity-modulated radiotherapy, prognostic factor, survival

Background Systemic inflammation and immune dysfunction has been proved to be significantly associated with cancer progression and metastasis in many cancer types, including colorectal cancer. We examined the prognostic significance of the systemic immune-inflammation index (SII) in patients with metastatic colorectal cancer (mCRC) and the relationship between the lymphocytic response to the tumor and this index. Methods This retrospective study evaluated 240 consecutive patients with newly diagnosed stage IV mCRC who underwent surgical resection. The SII values were calculated based on preoperative laboratory data regarding platelet, neutrophil, and lymphocyte counts. Tumor-infiltrating lymphocytes were evaluated using the surgical specimens. The overall survival and their 95% confidence interval (95% CI) were estimated by regression analyses and the Kaplan–Meier method. Results After a mean follow-up of 26.7 (1.1–92.4) months, 146 patients (60.8%) died. In the univariate analysis, a high SII was significantly associated with poor overall survival (P = 0.009). The multivariable analysis also confirmed that a high SII was independently associated with poor overall survival (hazard ratio: 1.462, 95% confidence interval 1.049–2.038, P = 0.025). The SII value was significantly correlated with the TILs value at the tumor’s center (P = 0.04), but not at the invasive margin (P = 0.39). When we evaluated overall survival for groupings of the tumor-infiltrating lymphocytes and SII values, we identified three distinct prognostic groups. The group with low tumor-infiltrating lymphocyte values and high SII values had the worst prognosis. Conclusions A high SII value independently predicts poor clinical outcomes among patients with mCRC. In addition, combining the lymphocytic response to the tumor and SII could further enhance prognostication for mCRC. Electronic supplementary material The online version of this article (10.1186/s12967-018-1638-9) contains supplementary material, which is available to authorized users.