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Clinical Feasibility of Six Inflammatory Markers for Predicting the Mortality of Patients With Cancer: Longitudinal
Kangwei Wang1, Ce Shi2, Dingchao Xia3,4,5
1Department of Cardiology, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, China.
Background:
Emerging evidence indicates that inflammation plays a crucial role in cancer prognosis. Inflammatory response biomarkers are recognized as promising prognostic factors for mortality in patients with cancer.
Objective:
This study aims to evaluate the prognostic significance of the systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), inflammatory prognostic index (IPI), and C-reactive protein-albumin-lymphocyte (CALLY) index.
Methods:
Weighted Cox regression analyses, restricted cubic spline models, Kaplan-Meier survival curves, and receiver operating characteristic analyses were performed to assess the predictive value of the 6 inflammatory markers for mortality. Subgroup analyses and sensitivity analyses were conducted to examine associations within specific subpopulations.
Results:
Cox regression models demonstrated that SIRI, NLR, IPI, and CALLY were significant predictors of all-cause mortality (tertile 3 vs tertile 1; hazard ratio [HR]: SIRI: 1.72, 95% CI 1.29-2.27; NLR: 1.33, 95% CI 1.02-1.74; IPI: 1.48, 95% CI 1.14-1.92; CALLY: 0.66, 95% CI 0.51-0.85). IPI (HR 1.91, 95% CI 1.11-3.27) and CALLY (HR 0.53, 95% CI 0.31-0.90) were significantly associated with cancer-specific mortality, whereas only SIRI was able to predict cardiovascular mortality (P value for trend=.04). Dose-response relationships were observed between the 6 inflammatory markers and mortality outcomes. Kaplan-Meier survival curves further illustrated significant differences between tertile groups (log-rank test, P<.001). The 6 inflammatory indices exhibited moderate predictive ability for all-cause mortality. IPI yielded the highest area under the curve (AUC) for cancer-specific mortality (AUC=0.6338), and SIRI was the most efficient predictor of cardiovascular mortality (AUC=0.687). No significant interactions were observed between the 6 inflammatory markers and most subgroup variables.
Conclusions:
SIRI, NLR, IPI, and CALLY represent convenient and cost-effective prognostic tools for predicting mortality in patients with cancer. In contrast, SII and PLR may not be reliable prognostic biomarkers.
