A Prognostic Nomogram Combining Postoperative SII and PIV Improves Long-Term Survival Prediction in NSCLC

Area of Science:

• Oncology
• Immunology
• Biostatistics

Background:

• Systemic inflammation significantly impacts non-small cell lung cancer (NSCLC) progression and prognosis.
• The prognostic utility of perioperative inflammatory markers in NSCLC remains insufficiently explored.

Purpose of the Study:

• To evaluate the prognostic value of five inflammatory indices: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV).
• To develop and validate a nomogram for individualized risk stratification in NSCLC patients undergoing resection.

Main Methods:

• Retrospective analysis of 243 NSCLC patients who underwent resection between 2015 and 2019.
• Calculation of pre- and postoperative inflammatory indices and their changes (Δ values).
• Prognostic marker identification using ROC analysis, Cox regression, LASSO, and stepwise selection; nomogram development and validation via a 70/30 hold-out split.

Main Results:

• Postoperative SII and PIV, along with their perioperative changes (ΔSII, ΔPIV), demonstrated superior prognostic performance over preoperative values.
• The developed nomogram, incorporating POST_SII, POST_PIV, TNM stage, smoking history, preoperative albumin, age, and gender, achieved a C-index of 0.85 in the training cohort and 0.80 in the validation cohort.
• The nomogram model outperformed traditional TNM staging and clinical models, showing enhanced net clinical benefit in decision-curve analysis.

Conclusions:

• Postoperative SII and PIV are robust inflammatory predictors of survival in patients following NSCLC resection.
• A nomogram integrating these postoperative inflammatory markers with clinical variables offers accurate and individualized risk stratification for NSCLC patients.