The Prognostic Value of the New Combined Hemo-Eosinophil Inflammation Index (HEI Index): A Multicenter Analysis of Anal Cancer Patients Treated with Concurrent Chemo-Radiation
by
, , , ,
Margherita Rimini
1,†, 
Pierfrancesco Franco
2,*,†
,
Berardino De Bari
3,4,
Maria Giulia Zampino
5,
Stefano Vagge
6
,
Giovanni Luca Frassinetti
7,
Francesca Arcadipane
2,
Almalina Bacigalupo
6,
Martina Valgiusti
7,
Deborah Aloi
3,
Lorenzo Gervaso
5,
Renzo Corvò
8,
Giulia Bartolini
7,
Marianna Alessandra Gerardi
9,
Stefano Cascinu
10 and
Andrea Casadei-Gardini
10 1
Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 41000 Modena, Italy
2
Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy
3
Department of Radiation Oncology, University Hospital of Besançon, 25000 Besançon, France
4
Department of Radiation Oncology, Réseau Hospitalier Neuchâtelois, 2300 La Chaux-de-Fonds, Switzerland
5
Division of Gastrointestinal Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, 20019 Milan, Italy
6
Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, 16121 Genova, Italy
7
Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori ‘Dino Amadori’–IRST, 47014 Meldola, Italy
8
Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Health Science Department (DISSAL), University of Genova, 16121 Genova, Italy
9
Division of Radiotherapy, European Institute of Oncology, IRCCS, 20019 Milan, Italy
10
Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, 20019 Milan, Italy
*
Author to whom correspondence should be addressed.
†
Co-first authors.
Cancers 2021, 13(4), 671; https://doi.org/10.3390/cancers13040671
Submission received: 14 January 2021
/
Revised: 1 February 2021
/
Accepted: 3 February 2021
/
Published: 7 February 2021
(This article belongs to the Special Issue Cancer Radiotherapy)
Simple Summary
Bio-humoral predictors of response to chemo-radiation in anal cancer patients are limited, but they might be a useful tool to select patients according to the risk of recurrence, to offer personalized treatments and follow-up protocols during and after therapy. We previously demonstrated the prognostic value of baseline Systemic Inflammation Index (SII), baseline hemoglobin level, and eosinophil count in this clinical setting. In the present study, we proposed a simple scoring system that includes all these three parameters, and we assessed its prognostic value. If validated, this new scoring system could represent a simple tool that is able to drive clinical decision-making in anal cancer patients treated with chemo-radiation with definitive intent.
Abstract
Anal squamous cell carcinoma (SCC) is a rare tumor, and bio-humoral predictors of response to chemo-radiation (CT-RT) are lacking. We developed a prognostic score system based on laboratory inflammation parameters. We investigated the correlation between baseline clinical and laboratory variables and disease-free (DFS) and overall (OS) survival in anal SCC patients treated with CT-RT in five institutions. The bio-humoral parameters of significance were included in a new scoring system, which was tested with other significant variables in a Cox’s proportional hazard model. A total of 308 patients was included. We devised a prognostic model by combining baseline hemoglobin level, SII, and eosinophil count: the Hemo-Eosinophils Inflammation (HEI) Index. We stratified patients according to the HEI index into low- and high-risk groups. Median DFS for low-risk patients was not reached, and it was found to be 79.5 months for high-risk cases (Hazard Ratio 3.22; 95% CI: 2.04–5.10; p < 0.0001). Following adjustment for clinical covariates found significant at univariate analysis, multivariate analysis confirmed the HEI index as an independent prognostic factor for DFS and OS. The HEI index was shown to be a prognostic parameter for DFS and OS in anal cancer patients treated with CT-RT. An external validation of the HEI index is mandatory for its use in clinical practice.
