Prognostic predictive value of the preoperative systemic immunoinflammatory index combined with the neutrophil‑to‑lymphocyte ratio in patients with primary liver cancer undergoing transarterial chemoembolization

Primary liver cancer (PLC) is a common type of malignant tumor, characterized by high morbidity and mortality worldwide, a poor prognosis, and a lack of reliable and effective prognostic predictors. The systemic immunoinflammatory index (SII) and the neutrophil-to-lymphocyte ratio (NLR) are key indicators of immunoinflammation in the body, and their combined clinical utility has not been fully explored in patients with PLC undergoing transarterial chemoembolization. In the present study, the association between the preoperative SII combined with the NLR and the prognosis of patients with PLC undergoing percutaneous hepatic artery chemoembolization was investigated. Of the 311 patients diagnosed with PLC in Liuzhou Hospital of Traditional Chinese Medicine (Liuzhou, China) between March 2017 and October 2019, 122 were included in the study. The clinical data were collected, and the patients were categorized into a low SII group (SII <381.79; 45 patients) and a high SII group (SII ≥381.79; 77 patients), and a low NLR group (NLR <2.83; 55 patients) and a high NLR group (NLR ≥2.83; 67 patients) based on the optimal preoperative SII and NLR cutoff values. The predictive efficacy of SII and NLR on the prognosis of patients with PLC was analyzed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. The association between SII, NLR and clinicopathological parameters was analyzed using a χ² test, and overall survival (OS) was analyzed using Kaplan-Meier (K-M) survival analysis. Cox regression analysis was used to analyze the independent risk factors affecting prognosis and to investigate the ability of SII combined with NLR to predict PLC prognosis. The ROC curves showed that the optimal cut-off values for preoperative SII and preoperative NLR were 381.79 and 2.83, respectively. ROC curve analysis showed that both SII [AUC, 0.843; sensitivity, 92.5%; specificity, 65.3%; 95% confidence interval (CI), 0.766-0.919] and NLR (AUC, 0.836; sensitivity, 82.1%; specificity, 60.3%; 95% confidence interval, 0.761-0.911) both had good predictive efficacy in patients with PLC. The results of the ROC curve analysis for predicting postoperative death in patients with PLC showed that the AUC of SII combined with NLR (0.846) was higher than that of SII alone (0.843) (P<0.01) and NLR alone (0.836) (P<0.01). Additionally, the AUC of SII (0.843) was higher than that of NLR (0.836) (P<0.01). SII [hazard ratio (HR), 0.655; 95% CI, 0.485-0.885; P=0.006] and NLR (HR, 0.655; 95% CI, 0.485-0.885; P=0.006) were independent risk factors for PLC. Based on K-M survival curve analysis, patients with SII ≥381.79 and NLR ≥2.83 exhibited the shortest OS (P<0.01). These findings indicated that higher preoperative SII and NLR values suggest a poor prognosis for patients with PLC, and that the predictive value of the combination of the two factors is greater than that of each of them alone.