Keywords
1. Pan-immune-inflammation value
2. Head and Neck Squamous Cell Carcinoma
3. Prognostic Biomarker
4. PIV in Oncology
5. HNSCC Survival Rates
In a groundbreaking study published in the Acta Otorrinolaringologica Española, researchers from the Universitat Autònoma de Barcelona’s Department of Otorhinolaryngology and the Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN) have unveiled the prognostic potential of the pan-immune-inflammation value (PIV) in patients with head and neck squamous cell carcinoma (HNSCC). This landmark research, which holds significant implications for the treatment and survival of cancer patients, stretch over a seventeen-year period analyzing data from 1187 patients.
DOI: 10.1016/j.otoeng.2023.07.003
The article with the identifier S2173-5735(24)00009-7 was released ahead of print on January 14, 2024.
The Study in Focus
The Spanish team, led by Aina A. Sansa and including Cristina C. Valero, Albert A. Pujol, Blanca B. Sauter, Julia J. Gayà, Miquel M. Quer, and Xavier X. León, conducted a retrospective review of patients treated between 2000 and 2017 at their center. Researchers collected PIV values, calculated from a formula that includes neutrophils, monocytes, platelets, and lymphocytes, from blood analyses carried out within three weeks before starting treatment. PIV has surfaced as a metric that encapsulates the inflammatory and immune response of the body, previously proven relevant in other tumor types.
Main Findings
The findings were substantial with the PIV value manifesting significant associations with toxic consumption, tumor location, extension, and histological grading. A categorized approach to PIV levels established four distinct groups:
Category I: PIV < 136.3 (9.9% of patients)
Category II: PIV 136.3-451.1 (50.0%)
Category III: PIV 451.1-1,141.2 (30.1%)
Category IV: PIV > 1141.2 (9.9%)
An ordered and significant decrease in disease-specific survival rates was evident as the PIV category escalated, even after adjusting for the treatment type, tumor extension, or primary tumor location. The independent quality of the PIV category as a prognostic indicator for disease-specific survival shone through in multivariable analysis.
Implications for Head and Neck Cancer Management
These findings substantially shift the landscape of head and neck cancer prognostication. PIV’s robustness as a prognostic factor holds the promise of better tailored, personalized treatment strategies, offering a glimmer of hope that targeted therapies could improve outcomes where PIV suggests a higher risk of disease progression or poorer survival.
Potential Impact of PIV on Clinical Decisions
The quantifiable nature of PIV enables it to potentially inform clinical decisions, particularly concerning aggressive treatment options. As patients with increased PIV fall into higher-risk categories, clinicians may consider more intensive treatment regimens or proactive surveillance post-treatment. Conversely, those with a lower PIV may be spared from over-treatment, thereby avoiding the unnecessary side-effects and toxicities associated with the comprehensive cancer therapies.
References
1. Sansa, A. A., Valero, C. C., Pujol, A. A., Sauter, B. B., Gayà, J. J., Quer, M. M., & León, X. X. (2024). Prognostic capacity of PIV (pan-immune-inflammation value) in patients with head and neck squamous cell carcinoma. Acta Otorrinolaringologica Española. https://doi.org/10.1016/j.otoeng.2023.07.003
2. Coussens, L. M., & Werb, Z. (2002). Inflammation and cancer. Nature, 420(6917), 860-867. https://doi.org/10.1038/nature01322
3. Hanahan, D., & Weinberg, R. A. (2011). Hallmarks of cancer: The next generation. Cell, 144(5), 646-674. https://doi.org/10.1016/j.cell.2011.02.013
4. Templeton, A. J., McNamara, M. G., Šeruga, B., Vera-Badillo, F. E., Aneja, P., Ocaña, A., … & Tannock, I. F. (2014). Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis. JNCI: Journal of the National Cancer Institute, 106(6), dju124. https://doi.org/10.1093/jnci/dju124
5. Grivennikov, S. I., Greten, F. R., & Karin, M. (2010). Immunity, inflammation, and cancer. Cell, 140(6), 883-899. https://doi.org/10.1016/j.cell.2010.01.025
Conclusion
The innovative PIV biomarker not only sheds light on the complex interplays between inflammation, immune response, and cancer but also stands as a valuable tool in the prognostication of head and neck squamous cell carcinoma. The implications of this research could potentially extend to other cancer types where the immune milieu plays a significant role in disease progression and treatment response. PIV, therefore, emerges as a beacon in the stratification of cancer patients and personalization of therapeutic regimens, marking an advance in precision medicine and the ongoing quest for optimizing cancer care outcomes.