The time-series behavior of systemic inflammation-immune status in predicting survival of locally advanced non-small cell lung cancer treated with chemoradiotherapy

Background:Systematic inflammation is believed to play a crucial role in tumorigenesis and metastasis.This study aims at evaluating the prognostic value of time-series behavior of systematic inflammation-immune status before and after definitive chemoradiotherapy(dCRT)in patients with locally advanced non-small cell lung cancer(LA-NSCLC).Methods:The relationship between systematic inflammation-immune score(SIS,defined as pretreatment periph-eral platelet count×neutrophil count/lymphocyte count)and the prognosis was tested in a retrospective study of 386 consecutive LA-NSCLC patients(Group A)with pretreatment SIS and 161 patients(Group B)with SIS before and one month after the dCRT.Results:SIS of 1400×10^(9)was found to be an optimal cutoffpoint to stratify the patients into high(>1400×10^(9))and low(≤1400×10^(9))SIS groups.Univariate and multivariate analyses revealed that the SIS,whether before or after dCRT,was an independent predictor for overall survival(OS),progress-free survival(PFS),and distant metastasis-free survival(DMFS).High SIS(>1400×10^(9))was shown to predict poor 3-year OS(P=0.006,hazard ratio[HR]=2.427),PFS(P=0.001,HR=2.442)and DMFS(P=0.015,HR=2.119).However,SIS was not related to local regional recurrence-free survival in either Group A(P=0.346)or Group B(P=0.486).Further,the area under the receiver operating characteristic curve of the SIS for OS was higher than the neutrophil count/lymphocyte count ratio,platelet count/lymphocyte count ratio,and other conventional clinic-pathological indices.Conclusions:The SIS is a stable and more sensitive survival predictor than other inflammation-based factors and conventional clinical indices,which may aid in more accurately stratifying patients for risk assessment and treatment decisions.