治疗前系统免疫炎症指数与食管癌患者预后关系的meta分析

Meta-analysis of the association between pretreatment systemic immune inflammation index and prognosis in esophageal cancer

目的探究治疗前系统免疫炎症指数(systemic immune inflammation index,SII)与食管癌患者预后的关系。方法通过计算机检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、维普、中国生物医学文献数据库、万方等数据库从建库至2018年12月公开发表的有关治疗前SII与食管癌患者预后关系的文献,SII计算式为中性粒细胞计数×血小板计数/淋巴细胞计数;主要终点指标为总生存期(overall survival,OS),次要终点指标为肿瘤相关生存期和无病生存期;采用Stata 12.0软件进行meta分析,合并值为风险比(hazard ratio,HR)和95%置信区间(confidence interval,CI)。结果最终纳入6项回顾性研究,共2 376例食管癌患者,均来自中国或日本;meta分析结果显示,治疗前SII较高与食管癌患者OS缩短明显相关[HR=1.50,95%CI(1.15,1.95),P=0.002];针对OS的亚组分析显示SII在经手术治疗[HR=1.54,95%CI(1.14,2.08),P=0.005]、食管鳞状细胞癌[HR=1.50,95%CI(1.11,2.02),P=0.007]患者中有较高预后价值,但SII与经放射治疗的食管癌患者预后无明显相关性[HR=1.318,95%CI(0.611,2.841),P=0.482];相较于中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值这两个指标,SII在食管癌预后方面有着更高的预测价值。结论治疗前SII较高可能是中国和日本食管癌患者预后不良的一个独立危险因素,尤其是经手术治疗的食管鳞状细胞癌患者。但仍需更多大样本、来自其他国家或地域的前瞻性研究进一步验证上述结果。

Objective To explore the correlation of pretreatment systemic immune inflammation index(SII with prognosis in esophageal cancer patients. Methods We searched the PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, Chinese Biology Medicine, and Wanfang databases to identify eligible studies evaluating the relation between pretreatment SII and prognosis in patients with esophageal cancer from establishment of databases to December 2018. SII was defined as the absolute neutrophil count multiplied by the absolute platelet count divided by the absolute lymphocyte count. The primary endpoint was overall survival(OS), and the secondary endpoints were cancer-specific survival and disease-free survival. The Stata 12.0 software was applied for the meta-analysis, and the hazard ratio(HR) and 95% confidence interval(CI) were assessed. Results A total of six retrospective studies involving 2 376 esophageal cancer patients were included and all patients were from China or Japan.The results revealed that elevated pretreatment SII was significantly associated with poor OS in esophageal cancer[HR=1.50, 95%CI(1.15, 1.95), P=0.002]. Subgroup analyses of OS indicated that SII had a high prognostic value in patients who received surgery [HR=1.54, 95%CI(1.14, 2.08), P=0.005] and were diagnosed as esophageal squamous cell carcinoma [HR=1.50, 95%CI(1.11, 2.02), P=0.007];however, no significant relation was observed between SII and prognosis in esophageal cancer patients who were treated with radiotherapy [HR=1.318, 95%CI(0.611, 2.841), P=0.482].Furthermore, compared with neutrophil to lymphocyte ratio and platelet to lymphocyte ratio, SII showed a higher predictive value for the prognosis of esophageal cancer. Conclusions Pretreatment SII may serve as an independent risk factor for prognosis of Chinese and Japanese esophageal cancer patients, especially patients who were treated with surgery and with esophageal squamous cell carcinoma. However, more prospective studies with big samples from other countries or regions are still needed to verify our findings.