The dynamic systemic immuno-inflammatory index: a novel predictor of neoadjuvant chemotherapy response and outcome in high-risk pediatric neuroblastoma.
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BACKGROUND: High-risk neuroblastoma (HR-NB) has a high mortality rate and a long-term survival rate below 50%. Neoadjuvant chemotherapy (NAC) is essential for HR-NB treatment. However, real-time treatment response biomarkers are lacking. The Systemic Immune-Inflammation Index (SII) shows promise as a prognostic tool for various malignancies. This study explored the relationship between dynamic SII changes during NAC and treatment responses and prognosis in HR-NB. METHODS: This retrospective study analyzed 50 HR-NB patients' clinical data from January 2013 to November 2024. Peripheral blood samples were collected before and after each cycle of neoadjuvant chemotherapy (NAC) to calculate SII values. RESULTS: Significant differences in SII changes were found among treatment response groups (P < 0.05). Spearman analysis showed a strong positive correlation between ΔSII and tumor diameter change rate (r = 0.606, P < 0.001). Regression analyses indicated ΔSII was an independent predictor of tumor diameter change (β = 0.07, 95% CI: 0.05-0.10, P < 0.001) and chemosensitivity (OR = 0.00, 95% CI: 0.00-0.03, P = 0.010). ΔSII was also an independent prognostic factor for EFS and OS (HR = 1.35 and 1.41, P < 0.05) with high predictive accuracy (AUC: 0.766-0.932). CONCLUSION: Dynamic SII changes during NAC are significantly linked to treatment response and prognosis in HR-NB, offering a new perspective for precision treatment and prognosis evaluation.