Systemic Immune-inflammation Index Predicting The Long-term Survival Of Patients With Esophageal Squamous Cell Carcinoma Treated By IMRT

Objective: The purpose of this study is to clear which systemic immunoinflammatory parameters pre-and post-radiotherapy have the predicting prognosis value in patients with ESCC after radiotherapy.Methods: A retrospective study was performed on 248 ESCC patients treated in our hospital from 2013 to 2015.Recorded the patient’s blood routine results before and after radiotherapy in detail,and calculate the corresponding systemic immune inflammation index(SII),prognostic nutrition index(PNI),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)And monocyte to lymphocyte ratio(MLR)and other influence factors.All patients received IMRT(95% PTV was 50-66 Gy / 25-33 F,1.8-2.0Gy / F,5F / W)± chemotherapy and eligible for enrollment.SPSS22.0 software was used for statistical analysis.Kaplan-Meier method was used to analyze the overall survival(OS),progression-free survival(PFS),and local control(LC)of the patients.The prognostic significance of above showing parameters were determined by univariate and multivariate analysis.The Systemic Immune Inflammation Index(SII)was calculated based on the ROC curve to determine the optimal cut-off value.The other parameters were determined according to the median grading standard.The predicting prognosis value of SII,NLR,PLR and MLR per-and post-radiotherapy were evaluated.By generating the ROC curve and the area under ROC curve(AUROCs)were measured and compared.Results: The entire group of 248 ESCC patients received definitive radical radiotherapy or radio-chemotherapy.The follow-up ended on October 20,2019.Four patients were lost to follow-up,and the follow-up rate was 98.3%.the sample number of patients in 1,3,5 years were 185,87,and 29,respectively.The 1,3,and 5 year overall survival(OS)rates were 74.6%,36.8%,and 26.5%,and the 1,3,and 5 year progression-free survival(PFS)rates were 58.4%,31.3%,and 20.5%,and the local control(LC)rates of 1,3 and 5 years were 71.0%,48.1%,and 39.6%,respectively.In univariate analysis,traditional prognostic factors including lesion site,lesion length,T staging,N staging,TNM staging,chemotherapy,radiation prescription dose and radiatherapy modelity were still affected OS and PFS(P <0.05).Post-radiotherapy SII,NLR,PLR,and MLR had significantly influence on OS,PFS,and LC,and patients with lower value had the better OS,PFS,and LC.before and after radiotherapy PNI represent the nutritional status of patients,with higher PNI value had a better prognosis than that patients with lower PNI value.In addition,multivariate analysis showed that N stage,chemotherapy,radiotherapy prescribed dose after radiotherapy SII,PNI,and MLR were independent prognostic factors for OS,PFS,and LC.Finally,the ROC curve was used to evaluate the role of various parameters in predicting OS.Before and after radiotherapy the value of SII,NLR,PLR,and MLR were closely related to the prognosis of patients.Further more,after radiotherapy SII(AUROC 0.65)predicted the great power of OS among all evaluated parameters.Conclusion:1.These value of SII,PNI,and peripheral blood cell count and its ratio(NLR,PLR,MLR)were important predicting parameters of OS,PFS,and LC in patients with esophageal squamous cell carcinoma treated by radiotherapy ± chemotherapy.2.These value of SII,PNI,NLR,PLR,and MLR of pre-and post-radiotherapy were related to the prognosis of patients with ESCC and those value of parameters with post-radiotherapy had more stronger role,at the end,the value of SII had the strongest predictive effect.3.This study had several limitations that should be highlighted.Our results may be inevitable influenced by the selection bias due to its retrospective nature and less number patients from a single institution.Therefore,the results of SII,PNI and blood cell counts and its ratios should be validated by multicenter studies prospectively in future.