系统免疫炎症指数与胃癌患者预后关系的Meta分析

Prognostic value of the systemic immune-inflammation index in patients with gastric cancer:a Meta-analysis

背景与目的:系统性免疫炎症指数(SII)一种新的炎症和预后标志物,但其与胃癌患者预后之间的关系仍有争议。因此,本研究通过系统评价和Meta分析评估SII与胃癌患者预后的关系,以为临床决策提供循证医学证据。方法:检索PubMed、EMBASE、Web of Science、Cochrane Library数据库,收集SII与胃癌患者预后关系的队列研究,检索时间均为建库至2020年7月28日。由2名研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险,采用Stata 12.0件进行数据分析。结果:共纳入12项回顾性队列研究,包括7244例患者。Meta分析结果显示,较高水平SII的胃癌患者总生存期(OS)与无病生存期(DFS)/无复发生存期(RFS)均缩短(HR=1.28,95%CI=1.16~1.41,P<0.001;HR=1.34,95%CI=1.06~1.70,P=0.013)。根据国家、治疗方案、样本量进行的亚组分析结果显示,较高水平SII均与OS缩短有关(均P<0.05)。SII达临界值600或以上时,较高水平SII与OS缩短有关(HR=1.56,95%CI=1.34~1.80,P<0.001),但SII在临界值600以下时,SII与OS无明显关系(P>0.05)。研究时间≥6年时,较高水平SII与OS缩短有关(HR=1.65,95%CI=1.21~2.25,P<0.001),但研究时间<6年时,SII与OS无明显关系(P>0.05)。此外,较高水平SII患者的TNM分期晚(OR=2.45,95%CI=1.75~3.44,P<0.001)、淋巴结转移风险高(OR=1.72,95%CI=1.27~2.32,P<0.001)、肿瘤体积大(OR=2.45,95%CI=1.75~3.44,P<0.001)、分化程度较差(OR=2.45,95%CI=1.75~3.44,P<0.001)。结论:SII可作为胃癌患者的预后标志物,较高水平SII的胃癌患者可能预后不良。受所纳入的研究数量与质量限制,上述结论尚待更多高质量研究予以验证。

Background and Aims:The systemic immune inflammation index(SII)is considered to be a new inflammatory and prognostic mark,but its relationship with the prognosis of gastric cancer patients is still controversial.Therefore,this study was conducted to evaluate the association between SII and the prognosis of gastric cancer patients through systematic review and Meta-analysis,so as to provide evidence-based medical information for clinical decision-making.Methods:The cohort studies on the relationship between SII and the prognosis of gastric cancer patients were collected by searching PubMed,EMBASE,web of science and Cochrane library databases.The retrieval time was from the database inception of to July 28,2020.After the literature screening,data extraction and assessment of bias risk of the included studies by two independent researchers,the data were analyzed by Stata 12.0 software.Results:A total of 12 retrospective cohort studies were included,including 7244 patients.Meta-analysis showed that the overall survival(OS)and disease-free survival(DFS)/recurrence free survival(RFS)were shortened in gastric cancer patients with higher SII value(HR=1.28,95%CI=1.16-1.41,P<0.001;HR=1.34,95%CI=1.06-1.70,P=0.013).Subgroup analyses stratified by country,treatment method and sample size all showed that higher SII value was associated with shorter OS(all P<0.05).When the SII value reached or exceeded the cut-off value of 600,the higher SII was associated with shortened OS(HR=1.56,95%CI=1.34-1.80,P<0.001),but when the SII value was lower than cut-off value of 600,there is no significant association between SII and OS(P>0.05).When the study time was≥6 years,the higher SII value was associated with the shorter OS(HR=1.65,95%CI=1.21-2.25,P<0.001),but there was no significant association between SII and OS when the study time was less than 6 years(P>0.05).In addition,patients with higher SII value were associated with advanced TNM stage(OR=2.45,95%CI=1.75-3.44,P<0.001),increased risk of lymph node metastasis(OR=1.72,95%CI=1.27-2.32,P<0.001),large tumor size(OR=2.45,95%CI=1.75-3.44,P<0.001),and poor differentiation(OR=2.45,95%CI=1.75-3.44,P<0.001).Conclusion:SII value can be used as a prognostic marker for gastric cancer patients,and those with relatively high SII value may face an unfavorable prognosis.However,the above conclusion still needs to be verified by more high-quality studies,due to the limitations in the number and quality of the included studies.