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Systemic Immune-Inflammation Index Predicts the Clinical Outcome in Patients with mCRPC Treated with Abiraterone
Cristian Lolli1, Orazio Caffo2, Emanuela Scarpi1
1Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico Meldola, Italy.
Insights
The systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) can predict outcomes for metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone. These easy-to-calculate markers may help identify high-risk patients early.
Area of Science:
- Oncology
- Immunology
- Prognostic Biomarkers
Background:
- The systemic immune-inflammation index (SII), derived from neutrophil, lymphocyte, and platelet counts, has prognostic value in various solid tumors.
- Metastatic castration-resistant prostate cancer (mCRPC) presents a significant clinical challenge, necessitating reliable prognostic tools.
- Abiraterone acetate is a standard treatment for mCRPC post-docetaxel therapy.
Purpose of the Study:
- To investigate the prognostic significance of the SII in mCRPC patients receiving abiraterone after docetaxel treatment.
- To evaluate the predictive value of SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) on overall survival (OS) and prostate-specific antigen (PSA) response rates.
Main Methods:
- Retrospective analysis of 230 mCRPC patients treated with abiraterone post-docetaxel.
- Calculation of SII, NLR, and PLR using complete blood count data.
- Kaplan-Meier analysis for OS, log-rank test for comparisons, and Cox regression for prognostic factor evaluation.
Main Results:
- Elevated SII (≥ 535), NLR (≥ 3), and PLR (≥ 210) were associated with higher risk.
- Median OS was significantly shorter in patients with high SII (14.7 months) compared to low SII (21.8 months) (p < 0.0001).
- Multivariate analysis confirmed SII and NLR as independent predictors of OS (HR=5.08, p<0.0001 and HR=1.90, p=0.001, respectively).
Conclusions:
- SII and NLR are valuable, easily accessible prognostic markers for mCRPC patients undergoing abiraterone treatment post-docetaxel.
- These indices may aid in early risk stratification and treatment decision-making.
- Further research is warranted to fully elucidate the role of SII and NLR in mCRPC management.
Abstract:
Background: A systemic immune-inflammation index (SII) based on neutrophil (N), lymphocyte (L), and platelet (P) counts has shown a prognostic impact in several solid tumors. The aim of this study is to evaluate the prognostic role of SII in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone post docetaxel. Patients and Methods: We retrospectively reviewed consecutive mCRPC patients treated with abiraterone after docetaxel in our Institutions. X-tile 3.6.1 software, cut-off values of SII, neutrophil-to-lymphocyte ratio (NLR) defined as N/L and platelets-to-lymphocyte ratio (PLR) as P/L. Overall survival (OS) and their 95% Confidence Intervals (95% CI) was estimated by the Kaplan-Meier method and compared with the log-rank test. The impact of SII, PLR, and NLR on overall survival (OS) was evaluated by Cox regression analyses and on prostate-specific antigen (PSA) response rates were evaluated by binary logistic regression. Results: A total of 230 mCRPC patients treated abiraterone were included. SII ≥ 535, NLR ≥ 3 and PLR ≥ 210 were considered as elevated levels (high risk groups. The median OS was 17.3 months, 21.8 months in SII < 535 group and 14.7 months in SII ≥ 535 (p < 0.0001). At univariate analysis Eastern Cooperative Oncology Group (ECOG) performance status, previous enzalutamide, visceral metastases, SII, NLR, and PLR predicted OS. In multivariate analysis, ECOG performance status, previous enzalutamide, visceral metastases, SII, and NLR remained significant predictors of OS [hazard ratio (HR) = 5.08, p < 0.0001; HR = 2.12, p = 0.009, HR = 1.77, 95% p = 0.012; HR = 1.80, p = 0.002; and HR = 1.90, p = 0.001, respectively], whereas, PLR showed a borderline ability only (HR = 1.41, p = 0.068). Conclusion: SII and NLR might represent an early and easy prognostic marker in mCRPC patients treated with abiraterone. Further studies are needed to better define their impact and role in these patients.
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