Inflammation and nutritional status indicators as prognostic indicators for patients with locally advanced gastrointestinal stromal tumors treated with neoadjuvant imatinib

Abstract

Background: Previous studies have confirmed that preoperative nutritional-inflammatory indicators can predict prognosis in various malignancies. However, to the best of our knowledge, no study has investigated the assessment of systemic inflammatory immunity index (SII) combined with prognostic nutritional index (PNI) scores to predict prognosis after neoadjuvant treatment with imatinib in locally advanced gastrointestinal stromal tumours (LA-GIST). The aim of this study was to evaluate the predictive value of pretreatment SII-PNI scores in predicting recurrence after neoadjuvant therapy with imatinib in patients with LA-GIST.

Methods: We retrospectively analyzed 57 patients with LA-GIST who received imatinib neoadjuvant from January 2013 to March 2019. Patients were divided into recurrence and non-recurrence groups according to their follow-up status, and SII and PNI cut-offs were calculated by receiver operating characteristic. The SII-PNI score ranged from 0 to 2 and were categorized into the following: score of 2, high SII (≥ 544.6) and low PNI (≤ 47.2); score of 1, either high SII (≥ 544.6) or low PNI (≤ 47.2); score of 0, no high SII (≥ 544.6) nor low PNI (≤ 47.2).

Results: All patients received imatinib neoadjuvant therapy for a median treatment period of 8.5 months (ranging from 3.2 to 12.6 months), with 8 patients (14.04%) and 49 patients (85.96%) developing recurrence and non-recurrence, respectively. Patients with a high SII-PNI score had a significantly worse recurrence-free survival time than those with a low SII-PNI score (P = 0.022, 0.046), and had a poorer pathological response (P = 0.014). Multivariate analysis demonstrated that the SII-PNI score was an independent prognostic factor for prediction of recurrence-free survival (P = 0.002).

Conclusion: The pre-treatment SII-PNI score can be used to predict the efficacy after neoadjuvant treatment with imatinib in patients with LA-GIST, which may be a promising predictor of recurrence-free survival time for patients.

Keywords: Gastrointestinal stromal tumors; Inflammation; Neoadjuvant therapy; Prognostic nutritional index.

Fig. 1

Correlation analysis between SII and PNI. A Pre-imatinib neoadjuvant therapy; B post-imatinib neoadjuvant therapy

Fig. 2

Relationship between recurrence and the SII(A/C)/PNI(B/D). A, B Before neoadjuvant treatment; C, D after neoadjuvant treatment

Fig. 3

ROC curves for discriminating patients with recurrence and those with non-recurrence according to values of the SII (A/C) and PNI(B/D). A, B Before neoadjuvant treatment; C, D after neoadjuvant treatment

Fig. 4

A waterfall plot of ranked best tumor shrinkage. Dashed lines indicate a 10% increase in tumor diameter from baseline for progression (progressive disease) and 10% for tumor regression (partial response). Of all LA-GIST patients treated with neoadjuvant imatinib, only 4 of 57 (7.02%) showed stable disease, while the remaining 53 patients (92.98%) showed partial responses and none showed disease progression

Fig. 5

Recurrence-free survival of LA-GIST patients with different SII-PNI scores. A Recurrence-free survival in patients with SII-PNI score of 0; B recurrence-free survival in patients with SII-PNI score of 1; C recurrence-free survival in patients with SII-PNI score of 2; D comparison of non-recurrence survival time of patients with different SII-PNI scores