Preoperative Systemic Inflammation Response Index Predicts Survival Outcome for Previously Irradiated Metachronous Secondary Head and Neck Cancer Patients.
Yan-Ye Su, Chih-Yen Chien, Wen-Ling Tsai, Ming-Hsien Tsai, Fu-Min Fang
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引用次数: 0
Abstract
Background: This study aimed to evaluate the survival predictability of preoperative systemic inflammation response index (SIRI), calculated as the absolute neutrophil count multiplied by the absolute monocyte count and divided by the absolute lymphocyte count, in patients with metachronous secondary primary head and neck squamous cell carcinoma (mspHNSCC) who had undergone prior radiotherapy for first primary HNSCC (fpHNSCC).
Methods: A total of 101 consecutive patients who underwent upfront surgery for mspHNSCC at a single institute between 2007 and 2016 were retrospectively reviewed between December 2023 and November 2024 and included in the analysis. The baseline leukocyte counts for the fpHNSCC and mspHNSCC were collected. Cox proportional hazards models were constructed using age and variables significant in univariate analysis to assess the impact of SIRI on overall survival (OS) and cancer-specific survival (CSS). Additionally, a SIRI-based nomogram was developed and validated.
Results: Statistically significant declines in baseline leukocyte counts were observed in mspHNSCC compared to fpHNSCC (p < 0.001). Among the inflammatory markers, the preoperative SIRI was the most predictive of survival outcomes for mspHNSCC. Higher SIRI values were significantly associated with poorer outcomes in both OS and CSS. The optimal SIRI cutoff for survival prediction was 1.383, as determined by receiver operating characteristic curve analysis with Youden's index; patients with SIRI ≥ 1.383 had significantly lower 5-year OS (32.9% vs 60.1%, p = 0.001) and CSS (64.7% vs 83.9%, p = 0.003). Multivariate analysis revealed lymphovascular invasion, extranodal extension, and high SIRI as independent adverse risk factors for CSS. The SIRI-based nomogram accurately predicted CSS, with a concordance index of 0.773.
Conclusion: Data from preoperative SIRI assessment, coupled with the presence of pathological adverse features, serve as valuable references for risk stratification in patients with previously irradiated mspHNSCC.
背景：本研究旨在评估术前系统性炎症反应指数（SIRI）的生存可预测性，该指数计算方法为中性粒细胞绝对计数乘以单核细胞绝对计数，再除以淋巴细胞绝对计数，计算方法为异时性继发性原发性头颈部鳞状细胞癌（mspHNSCC）患者先前接受过原发性头颈部鳞状细胞癌（fpHNSCC）放疗。方法：回顾性分析了2007年至2016年在同一研究所连续接受术前治疗的101例mspHNSCC患者，并于2023年12月至2024年11月纳入分析。收集fpHNSCC和mspHNSCC的基线白细胞计数。使用年龄和单因素分析中显著的变量构建Cox比例风险模型，评估SIRI对总生存期（OS）和癌症特异性生存期（CSS）的影响。此外，开发并验证了基于si的nomogram。结果：与fpHNSCC相比，mspHNSCC的基线白细胞计数有统计学意义上的显著下降（p < 0.001）。在炎症标志物中，术前SIRI最能预测mspHNSCC的生存结果。较高的SIRI值与较差的OS和CSS结果显著相关。用约登指数分析受试者工作特征曲线，确定生存预测的最佳SIRI截止值为1.383；SIRI≥1.383的患者5年OS （32.9% vs 60.1%, p = 0.001）和CSS （64.7% vs 83.9%, p = 0.003）显著降低。多因素分析显示，淋巴血管侵犯、结外延伸和高SIRI是CSS的独立不良危险因素。基于si的nomogram准确预测了CSS，其一致性指数为0.773。结论：术前SIRI评估数据，再加上病理不良特征的存在，为既往放疗过的mspHNSCC患者的风险分层提供了有价值的参考。
期刊介绍：
Cancer Management and Research is an international, peer reviewed, open access journal focusing on cancer research and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for cancer patients. Specific topics covered in the journal include:
◦Epidemiology, detection and screening
◦Cellular research and biomarkers
◦Identification of biotargets and agents with novel mechanisms of action
◦Optimal clinical use of existing anticancer agents, including combination therapies
◦Radiation and surgery
◦Palliative care
◦Patient adherence, quality of life, satisfaction
The journal welcomes submitted papers covering original research, basic science, clinical & epidemiological studies, reviews & evaluations, guidelines, expert opinion and commentary, and case series that shed novel insights on a disease or disease subtype.
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