Prognostic value of systemic immune-inflammation index in patients with locally advanced cervical cancer.
Authors: Torres-Cisneros Eduardo Rey , Hernandez-Barajas David , Zayas-Villanueva Omar Alejandro , Lara Jackeline Grace , Bruni-Guerrero Carla Renata , Reyna de la Garza Roberto Adrián , Martinez Moyano Javier Alejandro , Guerrero-González Marisol Denise , Mendoza C Ricardo , Gonzalez-Guerrero Juan Francisco , Vidal-Gutiérrez Oscar 
Published: June 2023

e17517 Background: Cervical cancer is the fourth most common cancer among women globally, more than 84% of cases occur in low-and middle-income countries. In Mexico is the second leading cause of cancer death in women. More than 9 of every 10 cases are caused by high-risk human papillomavirus. The interaction between inflammatory microenvironment and tumor cells has a profound impact in tumor growth and metastasis. The systemic immune-inflammation index (SII) is a novel, simple and accesible biomarker to prognosis of some malignant tumors, mainly in the situation with limited resources. Evidence is scarce about their prognostic value for locally advanced cervical cancer (LACC). Methods: We performed a retrospective analysis in a cohort of 223 LACC patients treated with concurrent chemoradiotherapy at an Oncology Reference Center in Mexico between 2010 and 2019. We collected clinicopathological and treatment data of all patientes. For each patient, SII index was calculated using the neutrophil, lymphocyte, and platelet measures obtained previous treatment. ROC curve analysis was utilized for the evaluation of optimal cut-off values for SII. Relapse-free survival (RFS) was estimated by the Kaplan-Meier method, and Odds ratio modeling used to determine risks. Results: The median age was 45.3 years (range 18-75y). Among all patients, 33.2% had obesity (BMI ≥30 kg/m2), and 32.2% had normal BMI. Two hundred cases (89%) were diagnosed with squamous cell carcinoma, with histological grade 2 in 78.5%. Based on the staging system, 43.5% presented metastasis to pelvic and/or para-aortic lymph nodes. Baseline anemia was present in 61% of all patients. All patients received platinum-containing concurrent chemotherapy with radiotherapy plus brachytherapy. Eighty-one patients (36.3%) presented recurrence of the disease. The results of the ROC curve analysis exhibited the optimal cut-off values at 6.43 x10 to the 5th power for RFS (AUC: 76.6%; sensitivity: 77.8%; and specificity: 61.3%). We stratificate patients in two groups for analysis: low-SII group with index ≤6.43 x10 to the 5th power, and high-SII group with index > 6.43 x10 to the 5th power. Patients with high-SII had a higher probability of having recurrence (odds 53%), and patients with low-SII had a probability of 17% for recurrence (p < 0.001). The odds ratio (OR) was 5.54 (95% IC, 2.97-10.32) for disease recurrence with a high-SII. In the high-SII group, the median RFS was 39 months, whereas for the low-SII group the median RFS not reached. Conclusions: In LACC patients, this study has shown that SII index was significantly associated with recurrence and RFS. LACC includes a heterogeneous group of patients. In the era of personalized medicine, this novel and accessible biomarker could be used in clinical practice to improve the accuracy of pre-treatment prognostic assessment and provide an opportunity to select patients who may benefit from tailor treatment.