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Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer

BACKGROUND: The systemic immune-inflammation index (SII) correlates with patient survival in various types of solid malignancies, including non-small cell lung cancer (NSCLC). However, limited information is available on the prognostic implication and disease-specific survival of SII in patients und...

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Autores principales: Keit, Emily, Coutu, Brendan, Zhen, Weining, Zhang, Chi, Lin, Chi, Bennion, Nathan, Ganti, Apar Kishor, Ernani, Vinicius, Baine, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940875/
https://www.ncbi.nlm.nih.gov/pubmed/33708854
http://dx.doi.org/10.21037/atm-20-6710
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author Keit, Emily
Coutu, Brendan
Zhen, Weining
Zhang, Chi
Lin, Chi
Bennion, Nathan
Ganti, Apar Kishor
Ernani, Vinicius
Baine, Michael
author_facet Keit, Emily
Coutu, Brendan
Zhen, Weining
Zhang, Chi
Lin, Chi
Bennion, Nathan
Ganti, Apar Kishor
Ernani, Vinicius
Baine, Michael
author_sort Keit, Emily
collection PubMed
description BACKGROUND: The systemic immune-inflammation index (SII) correlates with patient survival in various types of solid malignancies, including non-small cell lung cancer (NSCLC). However, limited information is available on the prognostic implication and disease-specific survival of SII in patients undergoing definitive chemoradiation therapy (CRT) for stage III NSCLC. METHODS: We retrospectively reviewed 125 patients who underwent curative intent CRT for stage III NSCLC with sufficient laboratory assessment from 2010–2019. SII was calculated at the time of diagnosis as platelet count × neutrophil count/lymphocyte count. Chi-squared analysis was used to compare categorical variables. A Kaplan-Meier analysis was performed to estimate progression-free survival (PFS), disease specific survival (DSS), and overall survival (OS) rates, with Cox regression used to determine absolute hazards. RESULTS: At a median follow-up of 19.7 months, 5-year OS, DSS, and PFS rates were 22.6%, 30.9%, and 13.4%, respectively. A low SII (<1,266) at diagnosis was independently associated with an improved OS (HR: 0.399, 95%, CI: 0.247–0.644, P<0.001), DSS (HR: 0.383, 95%, CI: 0.228–0.645, P<0.001), and PFS (HR: 0.616, 95%, CI: 0.407–0.932, P=0.022). We did not detect an association between SII and freedom from recurrence (FFR), freedom from locoregional recurrence (FFLRR), or freedom from distant recurrence (FFDR). NSAID (1,483.4 vs. 2,302.9, P=0.038) and statin usage (1,443.9 vs. 2,201.7, P=0.046) were associated with a lower SII while COPD exacerbations (2,699.7 vs. 1,573.7, P=0.032) and antibiotic prescriptions (2,384.6 vs. 1,347.9, P=0.009) were associated with an elevated SII. These factors were not independently associated with improved survival outcomes. CONCLUSIONS: Low SII scores were independently associated with improved OS, DSS, and PFS rates in patients with stage III NSCLC undergoing definitive CRT. NSAIDs and statin usage may be associated with lower SII at diagnosis of NSCLC. This study suggests that SII may be an effective prognostic indicator of patient mortality. Further investigation of the therapeutic potential of these agents in patients with an elevated SII in this setting may be warranted.
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spelling pubmed-79408752021-03-10 Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer Keit, Emily Coutu, Brendan Zhen, Weining Zhang, Chi Lin, Chi Bennion, Nathan Ganti, Apar Kishor Ernani, Vinicius Baine, Michael Ann Transl Med Original Article BACKGROUND: The systemic immune-inflammation index (SII) correlates with patient survival in various types of solid malignancies, including non-small cell lung cancer (NSCLC). However, limited information is available on the prognostic implication and disease-specific survival of SII in patients undergoing definitive chemoradiation therapy (CRT) for stage III NSCLC. METHODS: We retrospectively reviewed 125 patients who underwent curative intent CRT for stage III NSCLC with sufficient laboratory assessment from 2010–2019. SII was calculated at the time of diagnosis as platelet count × neutrophil count/lymphocyte count. Chi-squared analysis was used to compare categorical variables. A Kaplan-Meier analysis was performed to estimate progression-free survival (PFS), disease specific survival (DSS), and overall survival (OS) rates, with Cox regression used to determine absolute hazards. RESULTS: At a median follow-up of 19.7 months, 5-year OS, DSS, and PFS rates were 22.6%, 30.9%, and 13.4%, respectively. A low SII (<1,266) at diagnosis was independently associated with an improved OS (HR: 0.399, 95%, CI: 0.247–0.644, P<0.001), DSS (HR: 0.383, 95%, CI: 0.228–0.645, P<0.001), and PFS (HR: 0.616, 95%, CI: 0.407–0.932, P=0.022). We did not detect an association between SII and freedom from recurrence (FFR), freedom from locoregional recurrence (FFLRR), or freedom from distant recurrence (FFDR). NSAID (1,483.4 vs. 2,302.9, P=0.038) and statin usage (1,443.9 vs. 2,201.7, P=0.046) were associated with a lower SII while COPD exacerbations (2,699.7 vs. 1,573.7, P=0.032) and antibiotic prescriptions (2,384.6 vs. 1,347.9, P=0.009) were associated with an elevated SII. These factors were not independently associated with improved survival outcomes. CONCLUSIONS: Low SII scores were independently associated with improved OS, DSS, and PFS rates in patients with stage III NSCLC undergoing definitive CRT. NSAIDs and statin usage may be associated with lower SII at diagnosis of NSCLC. This study suggests that SII may be an effective prognostic indicator of patient mortality. Further investigation of the therapeutic potential of these agents in patients with an elevated SII in this setting may be warranted. AME Publishing Company 2021-02 /pmc/articles/PMC7940875/ /pubmed/33708854 http://dx.doi.org/10.21037/atm-20-6710 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Keit, Emily
Coutu, Brendan
Zhen, Weining
Zhang, Chi
Lin, Chi
Bennion, Nathan
Ganti, Apar Kishor
Ernani, Vinicius
Baine, Michael
Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title_full Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title_fullStr Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title_full_unstemmed Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title_short Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer
title_sort systemic inflammation is associated with inferior disease control and survival in stage iii non-small cell lung cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940875/
https://www.ncbi.nlm.nih.gov/pubmed/33708854
http://dx.doi.org/10.21037/atm-20-6710
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