Association of systemic immune-inflammation index with all-cause, cardiovascular and cancer-related mortality in cancer survivors : A population-based cohort study
- 1Department of Medical Imaging, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- 2School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China.
Abstract
Chronic inflammation plays an important role in the development of multiple diseases, including carcinogenesis and cancer progression. The systemic immune-inflammation index (SII), a composite biomarker derived from routine blood cell counts, reflects systemic inflammatory status. However, whether this index is associated with mortality outcomes among diverse cancer survivors in a nationally representative population remains unclear. This study aimed to investigate the associations between SII and all-cause, cardiovascular, and cancer-related mortality among cancer survivors in the United States. This study included 2624 cancer survivors from the National Health and Nutrition Examination Survey cycles conducted between 1999 and 2018, with mortality follow-up through December 31, 2019. Cox proportional hazards models were used to evaluate the associations between SII and mortality outcomes. Restricted cubic spline analyses, piecewise linear regression, and subgroup analyses were further performed to examine potential nonlinear associations. In the fully adjusted model, the adjusted hazard ratio for all-cause mortality was 1.39 (95% confidence interval [CI], 1.19–1.62) for participants in Q3 compared with those in Q2. For cancer-related mortality, the adjusted hazard ratios were 1.61 (95% CI, 1.19–2.19) for Q1 and 1.60 (95% CI, 1.19–2.15) for Q3, respectively, compared with Q2. Restricted cubic spline analysis revealed a U-shaped nonlinear association between lnSII (ln-transformation SII) and all-cause mortality and cancer-related mortality, with inflection points of 6.251 and 6.326, respectively. Our findings suggest a U-shaped nonlinear association between lnSII and all-cause mortality and cancer-related mortality in cancer survivors. SII may represent a potential biomarker for future mortality risk-stratification research; however, its clinical utility requires further validation in prospective studies and external cohorts.
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BibTeX
@article{song2026association,
title = {{Association of systemic immune-inflammation index with all-cause, cardiovascular and cancer-related mortality in cancer survivors : A population-based cohort study}},
author = {Lian Song and Haitao Zhu and Xiongfeng Cao and Yuting Gao and Dongqing Wang},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051351},
url = {https://europepmc.org/article/PMC/PMC13727174},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of systemic immune-inflammation index with all-cause, cardiovascular and cancer-related mortality in cancer survivors : A population-based cohort study
AU - Lian Song
AU - Haitao Zhu
AU - Xiongfeng Cao
AU - Yuting Gao
AU - Dongqing Wang
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051351
UR - https://europepmc.org/article/PMC/PMC13727174
AB - Chronic inflammation plays an important role in the development of multiple diseases, including carcinogenesis and cancer progression. The systemic immune-inflammation index (SII), a composite biomarker derived from routine blood cell counts, reflects systemic inflammatory status. However, whether this index is associated with mortality outcomes among diverse cancer survivors in a nationally representative population remains unclear. This study aimed to investigate the associations between SII and all-cause, cardiovascular, and cancer-related mortality among cancer survivors in the United States. This study included 2624 cancer survivors from the National Health and Nutrition Examination Survey cycles conducted between 1999 and 2018, with mortality follow-up through December 31, 2019. Cox proportional hazards models were used to evaluate the associations between SII and mortality outcomes. Restricted cubic spline analyses, piecewise linear regression, and subgroup analyses were further performed to examine potential nonlinear associations. In the fully adjusted model, the adjusted hazard ratio for all-cause mortality was 1.39 (95% confidence interval [CI], 1.19–1.62) for participants in Q3 compared with those in Q2. For cancer-related mortality, the adjusted hazard ratios were 1.61 (95% CI, 1.19–2.19) for Q1 and 1.60 (95% CI, 1.19–2.15) for Q3, respectively, compared with Q2. Restricted cubic spline analysis revealed a U-shaped nonlinear association between lnSII (ln-transformation SII) and all-cause mortality and cancer-related mortality, with inflection points of 6.251 and 6.326, respectively. Our findings suggest a U-shaped nonlinear association between lnSII and all-cause mortality and cancer-related mortality in cancer survivors. SII may represent a potential biomarker for future mortality risk-stratification research; however, its clinical utility requires further validation in prospective studies and external cohorts.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -