Prognostic value of systemic immune-inflammation index/serum albumin ratio in patients undergoing immunotherapy with opioids
Objective To assess the effect of systemic immune-inflammatory index/serum albumin ratio(SII/ALB)on the efficacy and prognosis of receiving opioids and immunotherapy in patients with cancer pain.Methods A total of 185 patients with cancer pain who were treated with both opioids and immune checkpoint inhibitors(ICIs)from September 1,2021 to September 1,2023 at Xuzhou Central Hospital were retrospectively analyzed.Patients'imaging and blood data were collected within 1 week before ICIs treatment.Receiver operating characteristic(ROC)curves were utilized to ascertain the optimal threshold values of SII/ALB.The chi-square test was used to analyze the relationship between SII/ALB and clinicopathological parameters.Kaplan-Meier curves and Cox proportional hazards models were used to investigate the effect of SII/ALB on progression-free survival(PFS).Results The cut-off value of SII/ALB was 22.31,and the patients were classified into low SII/ALB(SII/ALB ≤22.31)and high SII/ALB(SII/ALB＞22.31).SII/ALB was higher in patients with ECOG PS≥2,number of transfers＞2,medium to high opioid dose,adverse reactions grade 3-4,neutrophils＞1.8×109/L,lymphocytes≤ 1.1×109/L,monocytes＞0.6 g/L,platelets＞100×109/L,hemoglobin≤110 g/L,albumin≤35 g/L,IL-6＞5.4 pg/ml and systemic immune-inflammation index(SII)≤100.The objective response rate(ORR)and disease control rate(DCR)of the low SII/ALB group were 30.63％and 66.67％,respectively,which were higher than 6.76％and 14.86％of the high SII/ALB group,and the differences were statistically significant(P＜0.05).The Kaplan-Meier curve showed that elevated SII/ALB was associated with lower PFS.Patients with ICIs in the low SII/ALB group had longer PFS after opioid treatment compared to the high SII/ALB group(13.1 months vs.5.2 months,P＜0.001).The results of single factor Cox regression analysis showed that gender,ECOG PS,adverse reactions,IL-1β and SII/ALB were the factors affecting PFS(P＜0.05).The results of multivariate Cox regression analysis showed that gender(HR=1.865,95％CI:1.221-2.850,P=0.004),ECOG PS(HR=0.048,95％CI:0.021-0.114,P＜0.001),adverse reactions(HR=0.419,95％CI:0.231-0.762,P=0.026)and SII/ALB(HR=0.119,95％CI:0.073-0.194,P＜0.001)were independent prognostic factors affecting PFS.Conclusion SII/ALB can be used as a clinically convenient and effective biomarker,and it is an important prognostic parameter for predicting the prognosis of patients receiving opioids and immunothrapy.
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