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Respiratory Versus Gastrointestinal Malignancies: Systemic Inflammation, Cardiovascular Burden, and All-Cause
Bozhidar Krastev1,2, Natalia Spasova1,2, Petranka Troyanova3
1Department of Emergency Medicine, Medical University of Sofia, 1527 Sofia, Bulgaria.
Journal of Clinical Medicine
|July 28, 2026
Summary
The systemic immune-inflammation index (SII) is higher in respiratory system malignancies (RSM) and linked to increased mortality. While SII shows prognostic value, it
Area of Science:
- Oncology
- Cardiovascular Medicine
- Inflammation Research
Background:
- Systemic inflammation is prevalent in cancer patients, reflecting tumor activity and clinical status.
- The systemic immune-inflammation index (SII) is a simple marker derived from neutrophil, platelet, and lymphocyte counts.
- The prognostic significance of SII concerning cancer type, cardiovascular burden, and mortality requires further clarification.
Purpose of the Study:
- To compare cardiovascular comorbidity, inflammatory profile, and tumor characteristics between respiratory system malignancies (RSM) and gastrointestinal tract malignancies (GITM).
- To assess the association between the systemic immune-inflammation index (SII) and all-cause mortality in cancer patients.
- To evaluate the added prognostic value of SII in predicting mortality.
Main Methods:
- Analysis of 879 patients with solid malignancies (350 RSM, 529 GITM).
- Calculation of SII using the formula: platelet count × neutrophil count/lymphocyte count.
- Assessment of cardiometabolic and cardiovascular burden based on risk factors and existing diseases; primary outcome was all-cause mortality.
Main Results:
- Patients with RSM were younger, more often male, and had more advanced disease (Stage IV) compared to GITM.
- Mortality rates were higher in RSM (42.3%) than in GITM (29.9%), with correspondingly higher SII values in RSM (median 1117.8 vs. 716.8).
- Higher SII was significantly associated with increased all-cause mortality in the overall cohort (OR 1.11 per 1000-unit increase, p=0.013), with mortality rising across SII tertiles. The addition of SII to clinical models showed a modest increase in predictive accuracy (AUC 0.719 to 0.729).
Conclusions:
- The systemic immune-inflammation index (SII) is elevated in patients with respiratory system malignancies (RSM) and is associated with higher all-cause mortality.
- While SII demonstrates prognostic significance, its added value to established clinical predictors like tumor stage and metastatic disease is modest.
- SII should be considered a supportive inflammatory marker, integrated with other clinical factors for comprehensive patient assessment.
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