Associations between pretreatment systemic immune-inflammation index and tumor-specific prognosis in breast and gynecological cancers: an updated systematic review, meta-analysis, and certainty-of-evidence assessment
- 1Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University
- 2Graduate School of Guangxi Medical University
- 3Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Guangxi Medical University
Abstract
Introduction: Recent meta-analyses have assessed the prognostic value of the systemic immune-inflammation index (SII) in individual breast or gynecological cancers, but pooling these biologically distinct malignancies into one analysis has limited validity. Substantial differences in disease stage, treatment, SII thresholds, covariate adjustment, and outcome definitions add further uncertainty. This revised study therefore used a tumor-specific framework without assuming a common effect across female malignancies.
Methods: Four databases were searched through July 22, 2023, with structured top-up search and citation tracking through August 5, 2026. Current disease-specific meta-analyses served as quantitative sources when more robust than the original evidence; post-review primary studies were synthesized narratively to avoid double counting. Breast, cervical, ovarian, endometrial, and vulvar cancers were evaluated separately, with assessment of cohort overlap, residual confounding, sparse endpoints, threshold validity, heterogeneity, and certainty of evidence. No overall pooled estimate was calculated.
Results: The updated evidence map used current quantitative sources comprising 28 breast cancer studies (17,291 participants), 16 cervical cancer studies(2,840 participants), 10 ovarian cancer studies representing 11 cohorts (2,852 participants), and 8 endometrial cancer studies(2,315 participants). Targeted post-review updates included one additional cervical cancer cohort (470 participants), three later endometrial cancer reports, and three vulvar cancer reports(295 participants); these narrative updates were not added to the source-review denominators. Elevated SII was associated with poorer overall survival(OS), disease-free survival(DFS), and distant metastasis-free survival (DMFS) in breast cancer; poorer OS and progression-free survival (PFS) in cervical cancer; poorer OS and DFS in ovarian cancer; and poorer OS and PFS in endometrial cancer. The pathologic complete response (pCR) in breast cancer was not significantly associated with SII. The findings related to DMFS and vulvar cancer were statistically sparse. Substantial or very high heterogeneity persisted in several analyses, and all principal outcomes were rated as very-low-certainty evidence.
Conclusions: Elevated pretreatment SII was associated with adverse outcomes in several tumor-specific settings, but the magnitude and transportability of associations remain uncertain. Evidence cannot establish a universal threshold, confirm incremental prognostic value beyond established clinical factors, or support sufficient net benefit for treatment decisions. SII should therefore serve as an adjunct rather than a stand-alone clinical tool.
Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD 42023444334.
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BibTeX
@article{tong2026associations,
title = {{Associations between pretreatment systemic immune-inflammation index and tumor-specific prognosis in breast and gynecological cancers: an updated systematic review, meta-analysis, and certainty-of-evidence assessment}},
author = {Junru Tong and Junyou Su and Hongfei Chen and Yan Chen and Lingling Huang and Li Deng and Xiting Yan and Jiangtao Fan},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1631722},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1631722/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations between pretreatment systemic immune-inflammation index and tumor-specific prognosis in breast and gynecological cancers: an updated systematic review, meta-analysis, and certainty-of-evidence assessment
AU - Junru Tong
AU - Junyou Su
AU - Hongfei Chen
AU - Yan Chen
AU - Lingling Huang
AU - Li Deng
AU - Xiting Yan
AU - Jiangtao Fan
PY - 2026
DA - 2026/11/09
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1631722
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1631722/full
AB - Introduction: Recent meta-analyses have assessed the prognostic value of the systemic immune-inflammation index (SII) in individual breast or gynecological cancers, but pooling these biologically distinct malignancies into one analysis has limited validity. Substantial differences in disease stage, treatment, SII thresholds, covariate adjustment, and outcome definitions add further uncertainty. This revised study therefore used a tumor-specific framework without assuming a common effect across female malignancies. Methods: Four databases were searched through July 22, 2023, with structured top-up search and citation tracking through August 5, 2026. Current disease-specific meta-analyses served as quantitative sources when more robust than the original evidence; post-review primary studies were synthesized narratively to avoid double counting. Breast, cervical, ovarian, endometrial, and vulvar cancers were evaluated separately, with assessment of cohort overlap, residual confounding, sparse endpoints, threshold validity, heterogeneity, and certainty of evidence. No overall pooled estimate was calculated. Results: The updated evidence map used current quantitative sources comprising 28 breast cancer studies (17,291 participants), 16 cervical cancer studies(2,840 participants), 10 ovarian cancer studies representing 11 cohorts (2,852 participants), and 8 endometrial cancer studies(2,315 participants). Targeted post-review updates included one additional cervical cancer cohort (470 participants), three later endometrial cancer reports, and three vulvar cancer reports(295 participants); these narrative updates were not added to the source-review denominators. Elevated SII was associated with poorer overall survival(OS), disease-free survival(DFS), and distant metastasis-free survival (DMFS) in breast cancer; poorer OS and progression-free survival (PFS) in cervical cancer; poorer OS and DFS in ovarian cancer; and poorer OS and PFS in endometrial cancer. The pathologic complete response (pCR) in breast cancer was not significantly associated with SII. The findings related to DMFS and vulvar cancer were statistically sparse. Substantial or very high heterogeneity persisted in several analyses, and all principal outcomes were rated as very-low-certainty evidence. Conclusions: Elevated pretreatment SII was associated with adverse outcomes in several tumor-specific settings, but the magnitude and transportability of associations remain uncertain. Evidence cannot establish a universal threshold, confirm incremental prognostic value beyond established clinical factors, or support sufficient net benefit for treatment decisions. SII should therefore serve as an adjunct rather than a stand-alone clinical tool. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD 42023444334.
SN - 2234-943X
ER -