| Purpose:A meta-analysis was performed to systematically evaluate the effect of the systemic immune-inflammation index(SII)on the prognosis of patients with hepatocellular carcinoma(HCC).Methods:From the establishment of PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang and other relevant databases to January 2020,the published studies about the relationship between SII and the prognosis of patients with HCC were searched by computer.And the SII was defined as follows: SII= P×N/L,where P,N,and L were the platele,neutrophil,and lymphocyte counts,respectively.Two investigators independently selected the studies,then extracted the data and assessed the quality of the selected studies.Meta-analysis was conducted using Stata 12.0 software to summarize and analyze the extracted data.Results:A total of 14 documents with 4954 patients and 17 studies were included in this article.The primary survival indicator was overall survival(OS)and the secondary indicators were time to relapse(TTR),recurrence-free survival(RFS),progression-free survival(PFS),and post-relapse survival(PRS).The results of this meta-analysis are as follows:1.SII was associated with the shorter OS(HR = 1.61,95% CI: 1.47~1.76,P <0.001),TTR(HR = 1.81,95% CI: 1.31~2.50,P <0.001),RFS(HR = 1.48,95% CI: 1.25~1.75,P <0.001),PRS(HR = 1.92,95% CI: 1.33~2.78,P = 0.001),and the combined TTR and RFS of patients with HCC;and there was no significant statistical correlation with PFS(HR = 1.73,95% CI: 0.91~3.29,P = 0.095).2.The subgroup analysis results of SII and OS in HCC patients: in different regional groups: in both China group(HR = 1.71,95% CI: 1.51~1.49,P <0.001)and other countries group(HR = 1.71,95% CI:1.35~2.15,P <0.001),SII was significantly correlated with OS;in different treatment scheme groups: SII in surgical treatment group(HR = 1.97,95% CI: 1.62~2.40,P <0.001),non-surgical treatment group(HR = 1.87,95% CI: 1.53~2.30,P <0.001)and mixed treatment group(HR = 1.43,95% CI: 1.27~1.60,P <0.001)also had significant correlation with OS;in different blood collection time groups: both in all pretreatment group(HR=1.77,95%CI:1.56~2.01,P<0.001)and in the blood collection groups within 3 days before treatment(HR = 1.72,95% CI: 1.46~2.03,P < 0.001),1 week before treatment(HR = 2.49,95% CI: 1.59~3.90,P <0.001)and 1 month before treatment(HR = 1.72,95% CI: 1.22~2.43,P =0.002),SII was significantly correlated with OS;in different variable analysis method groups: SII was significantly correlated with OS in both multivariate analysis group(HR = 1.64,95% CI: 1.48~1.81,P <0.001)and univariate analysis group(HR=1.49,95% CI: 1.23~1.82,P <0.001);and in different threshold selection method groups: SII was also significantly correlated with OS in X-tile software group(HR = 1.85,95% CI: 1.43~2.40,P <0.001),ROC curve group(HR = 1.68,95% CI: 1.44~1.97,P <0.001)and R software group(HR = 2.45,95% CI: 1.35~4.45,P =0.003)were also.3.The results of comparision between SII and traditional clinical prognostic indicators: tumors size(>5cm)(HR = 2.71,95% CI: 1.91~3.84,P <0.001)and vascular invasion(HR = 1.85,95% CI: 1.18~2.88,P = 0.007)had a more strong correlation with the prognosis of HCC patients than SII(HR=1.61,95%CI:1.47~1.76,P<0.001);the prognostic correlation trend of TNM staging(HR = 1.50,95% CI: 1.33~1.69,P <0.001)with HCC patients was weaker than that of SII(HR=1.61,95%CI:1.47~1.76,P<0.001);Barcelona Clinic Liver Cancer Stageing System(BCLC staging)(HR = 1.70,95% CI: 0.83~3.51,P = 0.149),alpha-fetoprotein(AFP)(HR = 1.40,95% CI: 0.66~2.99,P = 0.380),and Child-Pugh classification(HR = 0.99,95% CI: 0.43~2.30,P = 0.980)were not statistically related to the prognosis of HCC patients.Conclusions:1.The elevated SII is related to the poor prognosis of HCC patients,which means the increase of SII may indicate that the OS,TTR,RFS and PRS of HCC patients are worse,while the effect on PFS is not clear at present.Therefore,clinical evaluation of SII level may have a certain guiding value for screening the poor prognosis population and carrying out individualized treatment.2.The ability of SII to evaluate the prognosis of HCC patients may be better than some traditional clinical prognosis indicators.What’s more,SII has the advantages of simplicity,low price,easy access and so on,which is expected to become a new prognosis marker of HCC. |
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