Correlation Analysis Of SIRI And PNI With Prognosis Of Oral Squamous Cell Carcinoma Patients

Objective:To analyze and investigate the association between Prognostic Nutritional Index(PNI),Systemic Inflammatory Response Index(SIRI)and clinical data related to oral squamous cell carcinoma patients and their effects on the prognosis of Oral Squamous Cell Carcinoma(OSCC)prognosis,and to develop a Nomogram line graph model related to oral squamous cell carcinoma accordingly,and to evaluate the clinical application efficacy of the Nomogram model established in this study to provide an aid for future clinical treatment and decision making.Materials and Methods:Cases of patients who came to our oral and maxillofacial surgery ward for oral squamous cell carcinoma-related treatment from January 2014 to June 2021 were collected,and a total of 405 cases with complete information were finally obtained through strict inclusion and exclusion criteria,and all clinical data information obtained was within 1 week before the patients received treatment.By telephone follow-up and patient review,the primary index of observation was recorded as Overall Survival(OS)and the secondary index of observation was Progression Free Survival(PFS).The optimal cut-off values for PNI and SIRI were determined by X-tile(version 3.6.1)and grouped accordingly.The correlation between PNI,SIRI and each clinical information was analyzed by IBM SPSS(version 26.0).Survival analysis was performed to investigate the factors influencing OS and PFS in oral squamous cell carcinoma by post-treatment survival of OSCC patients.Correlation graph plotting,Nomogram modeling and clinical efficacy evaluation were performed by Graphpad Prism(version 9.4.1)and R software(version 4.2.3).The model was evaluated by Concordance index(C-index)and Time-dependent Receiver Operating Characteristic Curves(time ROC)for differentiation,calibration curves for calibration,and decision curve analysis(decision curve analysis).The model was evaluated for clinical decision utility by Decision Curve Analysis(DCA).Results:The optimal cut-off value for PNI was 43.1 and for SIRI was 1.97 by X-tile.Compared with the low PNI group,the high PNI group had a lower proportion of elevated neutrophil count,a lower SIRI score,a lower proportion of large tumor diameter,and a lower neutrophil-to-lymphocyte ratio(Neutrophil-Lymphocyte Ratio.NLR and Monocyte to Lymphocyte Ratio(MLR)scores were much lower.Compared with the low SIRI group,the high SIRI group had a greater proportion of elevated neutrophil count and monocyte count,lower PNI score,more advanced TNM stage,and higher NLR and MLR scores.Univariate analysis suggested that PNI,SIRI,age,sex,neutrophil count,monocyte count,tumor diameter size,TNM stage,tumor site,NLR,MLR were prognostic influencing factors for progression-free survival(PFS).PNI,SIRI,age,sex,neutrophil count,monocyte count,tumor diameter size,TNM stage,lymph node palpation,tumor location,NLR,and MLR were prognostic influencers of overall survival(OS).The differences were statistically significant(P < 0.05).Multifactorial analysis suggested that PNI,SIRI,MLR,and tumor site were independent influencing factors for prognosis of PFS and OS in OSCC.The differences were statistically significant(P < 0.05).The Nomogram clinical prediction model was established based on the results of multifactorial analysis,and its consistency index was calculated as 0.752.The Area Under Curve(AUC)for the estimated survival rate at 2,3,and 5 years after initial treatment for OSCC was 0.804,0.772,and 0.783,respectively,indicating that the model had good discrimination.The calibration curves fit well,indicating that the model has good calibration.the DCA curves suggest that the Nomogram model constructed in this study has good clinical decision efficacy.Conclusion:1、 PNI level was positively correlated with the survival of OSCC patients,and SIRI level was negatively correlated with the survival of OSCC patients.Preoperative PNI≤43.1 and SIRI>1.97 indicated that patients with oral squamous cell carcinoma had a poor prognosis for survival.2、 PNI and SIRI are independent risk factors for progression-free survival(PFS)and overall survival(OS)in oral squamous cell carcinoma.3、 The Nomogram prediction model constructed in this study has a certain degree of differentiation,calibration and clinical decision-making efficacy,which can be used as a reference in clinical treatment and decision-making.