<p>Immune inflammation indicators in anal cancer patients treated with concurrent chemoradiation: training and validation cohort with online calculator (ARC: Anal Cancer Response Classifier)</p>

Abstract

Background: In anal cancer, there are no markers nor other laboratory indexes that can predict prognosis and guide clinical practice for patients treated with concurrent chemoradiation. In this study, we retrospectively investigated the influence of immune inflammation indicators on treatment outcome of anal cancer patients undergoing concurrent chemoradiotherapy. Methods: All patients had a histologically proven diagnosis of squamous cell carcinoma of the anal canal/margin treated with chemoradiotherapy according to the Nigro’s regimen. Impact on prognosis of pre-treatment systemic index of inflammation (SII) (platelet x neutrophil/lymphocyte), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were analyzed. Results: A total of 161 consecutive patients were available for the analysis. Response to treatment was the single most important factor for progression-free survival (PFS) and overall survival (OS). At univariate analysis, higher SII level was significantly correlated to lower PFS ( p <0.01) and OS ( p =0.046). NLR level was significantly correlated to PFS ( p =0.05), but not to OS ( p =0.06). PLR level significantly affected both PFS ( p <0.01) and OS ( p =0.02). On multivariate analysis pre-treatment, SII level was significantly correlated to PFS ( p =0.0079), but not to OS ( p =0.15). We developed and externally validated on a cohort of 147 patients a logistic nomogram using SII, nodal status and pre-treatment Hb levels. Results showed a good predictive ability with C-index of 0.74. An online available calculator has also been developed. Conclusion: The low cost and easy profile in terms of determination and reproducibility make SII a promising tool for prognostic assessment in this oncological setting.

Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients

“…Considering that recurrent inflammation episodes can promote the dysplasia-carcinoma sequence and a higher SII is a poor prognostic factor for response to treatment in SCC of the anus, defining high-risk patients for recurrence and individualizing treatment modalities are crucial for CA cases. 6,16 The strength of this study is its homogenous cohort of patients with CA with well-defined exclusion criteria, including autoimmune or other inflammatory disorders, which may have created a strong bias in terms of PIBs. The large sample size of the patients with CA, including those with recurrence and HSIL, is another superiority that renders the study unique in defining a stratification of CA patients according to risk groups.…”

“…2,3 In addition, from a biological standpoint, anogenital lesions ranging from low-to high-grade SIL may be a precursor for malignant transformation to anal cancer considering that 80-90% of anal squamous cell carcinomas are associated with these SILs. 5,6 Recurrence and carcinogenesis contribute to the failure of treatment; therefore, combined surgical and immune modulator therapies in these selected cases may be more effective than expected. 3 The neutrophilto-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are peripheral inflammatory biomarkers (PIBs) that have been validated as markers of systemic inflammation and present prognostic values in several neoplasia, including anal cancer.…”

“…3 The neutrophilto-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are peripheral inflammatory biomarkers (PIBs) that have been validated as markers of systemic inflammation and present prognostic values in several neoplasia, including anal cancer. [6][7][8] However, there is no research in the literature about the relationship of these biomarkers with SILs causing both the inflammation and neoplastic process of affected tissues. The aim of this study was to evaluate the predictive value of NLR, PLR, and SII for recurrence and SIL development in surgically-treated patients with anogenital CA.…”

The Prognostic Value of the New Combined Hemo-Eosinophil Inflammation Index (HEI Index): A Multicenter Analysis of Anal Cancer Patients Treated with Concurrent Chemo-Radiation

“…In the last few years, research interest has grown on the interplay between cancer, inflammation, and the immune system and several bio-humoral immune-based prognostic scores, such as Lymphocyte count, Neutrophil-Lymphocyte ratio (NLR), and Platelet-Lymphocyte ratio (PLR), have been identified as predictors of survival, recurrence, and treatment response in cancer patients [11][12][13]. In patients affected with anal cancer and treated with concurrent chemo-radiation (CT-RT), our group highlighted the prognostic value of the Systemic Index of Inflammation (SII) [14], low baseline Hb level [8], and high baseline eosinophil level [15] in predicting for poor response to CT-RT.…”

Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial

“…[4][5][6][7] Several papers in the literature have reported that inf lammatory indexes such as neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammatory index (SII) may have a predictive and prognostic role in various diseases. [8][9][10][11][12][13][14][15] We previously demonstrated in two different papers a correlation between CRP 16 and inflammation index 17 and clinical outcome in patients with metastatic CC undergoing first-line chemotherapy.…”