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 has been thought to play a crucial role in tumorigenesis and metastasis. This study is aimed to evaluate 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 relation between systematic inflammation-immune score (SIS, defined as pretreatment peripheral platelet count × neutrophil count / lymphocyte count) and 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 dCRT. Results SIS of 1400 × 109 was found to be an optimal cutoff point to stratify the patients into high (>1400 × 109) and low (≤1400 × 109) 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 × 109) 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 with Local regional recurrence-free survival either in 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 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 decision.