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Prognostic Value of the Systemic Immune-Inflammation Index (SII) After Neoadjuvant Therapy for Patients with Resected Pancreatic Cancer

  • Pranav Murthy
  • Mazen S. Zenati
  • Amr I. Al Abbas
  • Caroline J. Rieser
  • Nathan Bahary
  • Michael T. Lotze
  • Herbert J. ZehIII
  • Amer H. Zureikat
  • Brian A. BooneEmail author
Pancreatic Tumors

Abstract

Background

The systemic immune-inflammation index (SII), calculated using absolute platelet, neutrophil, and lymphocyte counts, has recently emerged as a predictor of survival for patients with pancreatic ductal adenocarcinoma (PDAC) when assessed at diagnosis. Neoadjuvant therapy (NAT) is increasingly used in the treatment of PDAC. However, biomarkers of response are lacking. This study aimed to determine the prognostic significance of SII before and after NAT and its association with the pancreatic tumor biomarker carbohydrate-antigen 19-9 (CA 19-9).

Methods

This study retrospectively analyzed all PDAC patients treated with NAT before pancreatic resection at a single institution between 2007 and 2017. Pre- and post-NAT lab values were collected to calculate SII. Absolute pre-NAT, post-NAT, and change in SII after NAT were evaluated for their association with clinical outcomes.

Results

The study analyzed 419 patients and found no significant correlation between pre-NAT SII and clinical outcomes. Elevated post-NAT SII was an independent, negative predictor of overall survival (OS) when assessed as a continuous variable (hazard ratio [HR], 1.0001; 95% confidence interval [CI] 1.00003–1.00014; p = 0.006). Patients with a post-NAT SII greater than 900 had a shorter median OS (31.9 vs 26.1 months; p = 0.050), and a post-NAT SII greater than 900 also was an independent negative predictor of OS (HR, 1.369; 95% CI 1.019–1.838; p = 0.037). An 80% reduction in SII independently predicted a CA 19-9 response after NAT (HR, 4.22; 95% CI 1.209–14.750; p = 0.024).

Conclusion

Post-treatment SII may be a useful prognostic marker in PDAC patients receiving NAT.

Notes

Disclosure

Dr. Nathan Bahary has held Advisory Roles/Boards for BioLIneRx, AstraZeneca, Exelixis, BMS, and Thermo Fisher. The remaining authors declare no conflict of interests.

Supplementary material

10434_2019_8094_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 39 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Pranav Murthy
    • 1
  • Mazen S. Zenati
    • 1
    • 2
  • Amr I. Al Abbas
    • 1
  • Caroline J. Rieser
    • 1
  • Nathan Bahary
    • 3
    • 4
  • Michael T. Lotze
    • 1
    • 5
    • 6
  • Herbert J. ZehIII
    • 7
  • Amer H. Zureikat
    • 1
  • Brian A. Boone
    • 8
    Email author
  1. 1.Department of SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Department of EpidemiologyUniversity of PittsburghPittsburghUSA
  3. 3.Department of Internal MedicineUniversity of PittsburghPittsburghUSA
  4. 4.Department of Molecular Genetics and BiochemistryUniversity of PittsburghPittsburghUSA
  5. 5.Department of ImmunologyUniversity of PittsburghPittsburghUSA
  6. 6.Department of BioengineeringUniversity of PittsburghPittsburghUSA
  7. 7.Department of SurgeryUniversity of Texas SouthwesternDallasUSA
  8. 8.Department of SurgeryWest Virginia UniversityMorgantownUSA

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