Increasing Systemic Immune-inflammation Index During Treatment in Patients With Advanced Pancreatic Cancer - A Retrospective, Multicenter, Cohort Study

Sep 24, 2026

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A retrospective, multicenter cohort study evaluates whether changes in the systemic immune-inflammation index (SIII) during treatment relate to outcomes in advanced pancreatic cancer. Patients treated with FOLFIRINOX alone or followed by stereotactic body radiotherapy (2015–2021) were analyzed using longitudinal joint models linked to time-to-event data. Among 141 patients, SIII log-values decreased during FOLFIRINOX, while higher log(SIII) predicted increased hazard of death. The findings position SIII as a reliable biomarker alongside CA 19-9 for survival prediction.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Background and Objectives

Methods

Results

Conclusions

Increasing Systemic Immune-inflammation Index During Treatment in Patients With Advanced Pancreatic Cancer is Associated With Poor Survival A Retrospective, Multicenter, Cohort Study Freek R. van ‘t Land, MD, * Mohammad H. Aziz, MD, * Nynke Michiels, MD,† J. Sven D. Mieog, MD, PhD,† Bert A. Bonsing, MD, PhD,† Saskia A. C. Luelmo, MD,‡ Marjolein Y. V. Homs, MD, PhD,§ Bas Groot Koerkamp, MD, PhD, * Grigorios Papageorgiou, MSc, PhD,∥¶ and Casper H.J. van Eijck, MD, PhD *✉ Background and Objectives: A high systemic immune-inﬂammation index (SIII) at diagnosis of various cancers, including pancreatic cancer, is associated with poor prognosis. The impact of FOLFIRINOX (5-ﬂuorouracil, leucovorin, irinotecan, and oxaliplatin) chemotherapy or stereotactic body radiotherapy on this index is unknown. In addition, the prognostic value of changes in the SIII during treatment is unclear. In this retrospective analysis, we aimed to ﬁnd answers regarding patients with advanced pancreatic cancer. Methods: Patients with advanced pancreatic cancer treated with FOLFIRINOX chemotherapy alone or with FOLFIRINOX chemotherapy followed by stereotactic body radiotherapy between 2015 and 2021 in 2 tertiary referral centers were included. Baseline characteristics, laboratory values at 3 time points during treatment, and survival outcomes were collected. The patient-speciﬁc evolutions of SIII and their association with mortality were assessed with joint models for longitudinal and time-to-event data. Results: Data of 141 patients were analyzed. At a median follow-up time of 23 .0 months (95% CI: 14 .6–31.3), 97 (69%) patients had died. Median overall survival was 13 .2 months (95% CI: 11 .0–15. 5) . During treatment with FOLFIRINOX, the log (SIII) was reduced by −0 . 588 (95% CI:−0 .0978, −0 . 197; P = 0.003) . One unit increase in log (SIII) increased the hazard ratio of dying by 1 .604 (95% CI: 1 .068–2.409; P = 0.023) . Conclusions: In addition to carbohydrate antigen 19-9, the SIII is a reliable biomarker in patients with advanced pancreatic cancer. From the *Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; †Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; ‡Department of Oncology, Leiden University Medical Center, the Netherlands; §Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; ∥Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; and ¶Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. ✉ [c.vaneijck@erasmusmc.nl](c.vaneijck@erasmusmc.nl). The authors report no conﬂicts of interest. Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, [www.annalsofsurgery.com](www.annalsofsurgery.com). This is an open access article distributed under the Creative Commons Attribution License 4 .0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2023 The Author(s) . Published by Wolters Kluwer Health, Inc. ISSN: 0003-4932/23/27806-1018 DOI: 10.1097/SLA.0000000000005865 [1018](1018 | www.annalsofsurgery.com)[ |](1018 | www.annalsofsurgery.com)[ www.annalsofsurgery.com](1018 | www.annalsofsurgery.com) Key Words: FOLFIRINOX chemotherapy, inﬂammation, pancreatic cancer, stereotactic body radiotherapy, systemic immune-inﬂammation index, survival (Ann Surg 2023;278:1018–1023) Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy. By 2030, it is anticipated to rank as the second leading cause of cancer-related fatalities in the United States.1 When diagnosed, the cancer is anatomically staged as resectable, borderline resectable, locally advanced, or metastasized pancreatic cancer. Unfortunately, due to the lack of symptoms and rapid

FAQs

What is the main goal of this study regarding SIII?

The study aims to determine whether the systemic immune-inflammation index (SIII) changes during treatment and whether those changes predict survival in patients with advanced pancreatic cancer.

How were patients treated in the included cohort?

Patients received FOLFIRINOX chemotherapy alone or FOLFIRINOX followed by stereotactic body radiotherapy between 2015 and 2021 at two tertiary centers.

What did the study find about SIII during FOLFIRINOX treatment?

During FOLFIRINOX treatment, the log(SIII) decreased, and each one-unit increase in log(SIII) was associated with a higher hazard of dying.

Sep 24, 2026

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