Evaluation of the relationship between SII, PNI and LAO prognosis in stage III and stage iv non-small cell lung cancer

Introduction and Aim: This study was planned to evaluate the relationship of systemic immune inflammation index (SII), prognostic nutritional index (PNI) and LDH/Albumin ratio (LAR) with progression-free survival (PS) and overall survival (OS) in patients with stage III-IV non-small cell lung cancer. Materials and Methods: In the study, all male and female patients over the age of 18, followed up with the diagnosis of stage III-IV non-small cell lung cancer, were evaluated retrospectively. Using exclusion criteria, 180 patients were included in the study. The data were evaluated with the IBM SPSS version 24.0 statistical analysis program. The Mann-Whitney U test was used to compare independent groups. PS and OS were defined for survival analysis. Overall survival was estimated using the Kaplan-Meier method, and the Cox regression model was utilized to analyze independent prognostic risk factors. Results: The median age of the patients was 65 (35-90) and 121 (71.1%) were male. Mean progression-free survival (PS) of the patients was 11.3±1.3 months, median PS of 8±0.6 months; their mean overall survival (OS) was 30.9±2.4 months, and their median OS was 21±1.8 months. In the multiple cox regression analysis of the parameters in which we investigated the relationship of the patients in our study with progression-free survival, patients with SII >1094.98 were found to be 1.4 times more likely to develop progression compared to patients with SII<1094.98 [HR=1.49 and 95%CI (1.01-2.21), p=0.042]. Statistically significant relationships were found between smoking history, gender, EGFR status and PS (p<0.000, p<0.000, p<0.000, respectively). It was observed that patients with a history of smoking were 2.4 times more likely to die than patients without a history of smoking. (HR=2.46 and 95%CI (1.49-4.07), p=0.000). In patients with metastases/stage IV, the risk of death was 1.7 times higher than in patients without metastasis/stage III [HR=1.71 and 95%CI (1.10-2.67), p=0.017]. Conclusion: In our study, a significant correlation was found between only Level II and progression-free survival in multivariate analysis. The factors constituting the limitation of our study were the fact that our study was single-center, retrospective, and the patient population was small, and the difference in survival between the groups due to the gradual development of current treatment options in non-small cell lung cancers. SII, PNI and LAR values should be examined as prognostic markers in both small cell lung cancer and other cancers with larger patient populations and prospective studies. Keywords: SII, PNI, LAR, non-small cell lung cancer prognosis