Clinical Value Of Systemic Immune Inflammatory Index In Predicting Prognosis Of Patients With Advanced Esophageal Cancer Treated With First-line Immune Therapy

Objective:To investigate the prognostic significance of systemic immunoinflammatory index(SII)in esophageal malignancies after first-line immunotherapy,and to compare the prognostic relationship between SII and platelet lymphocyte ratio(PLR),monocyte lymphocyte ratio(MLR),and neutrophil lymphocyte ratio(NLR).Methods:Clinical data of patients with esophageal malignancies who received first-line immunotherapy in North People’s Hospital of Jiangsu Province from January 2019 to June 2022 were selected.The optimal cut-off values of SII,NLR,MLR and PLR for overall survival were determined according to receiver operating characteristic curve(ROC),and the relationship between SII,NLR,MLR and PLR and prognosis was analyzed.The relationship between SII level and clinicopathologic features of patients was analyzed statistically.Univariate and multivariate Cox regression analysis of the risk factors affecting the survival and prognosis of patients with esophageal cancer receiving immunotherapy.Results:The best cut-off values of NLR,MLR,PLR and SII for survival were 3.15,0.38,180.58 and 2731.59,respectively.The AUC results showed that SII was superior to PLR,MLR and NLR.In terms of clinical efficacy,the low SII group had complete remission in 15 cases(22.1%),partial remission in 19 cases(30.1%),stable disease in 9 cases(13.2%),tumor progression in 29 cases(42.6%),and objective effective rate(complete remission+partial remission)in 44 cases(30.1%).The total control rate(complete response+partial response+stable)was 53 cases(65.4%).In the high SII group,there were 1 complete response(8%),2 partial response(17%),9 progressive cases(75%),and 3 objective response rate(complete response+partial response)and total control rate(complete response+partial response+stable)(25%).There were significant differences in objective effective rate and total control rate between the two groups(P<0.05),indicating that the low SII group had better clinical effect.Compared with the high-value group,patients with low SII and low NLR had longer PFS and OS(PFS and OS:P≤0.05).Univariate analysis showed that SII≤2731.59,chemotherapy and local treatment were associated with longer OS.SII≤2731.59,local treatment was associated with longer PFS.Multivariate analysis combined with tumor staging showed that SII≤2731.59 and local treatment was independently correlated with PFS and OS.Conclusion:In predicting the prognosis of patients with advanced esophageal malignancies receiving first-line immunotherapy,SII is significantly better than PLR,MLR and NLR.The lower the SII before treatment,the better the prognosis of patients.The disease control rate of patients with esophageal malignancies in the low SII group was significantly increased,and the 1-year progression-free survival rate and 1-year overall survival rate of patients were significantly higher,with higher clinical value.Patients with low SII combined with local treatment have better prognosis,and SII is an important prognostic indicator for patients with advanced esophageal malignancies.