The Association between the Pan-Immune-Inflammation Value and Cancer Prognosis: A Systematic Review and Meta-Analysis

Simple Summary Growing evidence indicates that blood-count-based compound scores could be used as prognostic biomarkers in cancer as reflectors of uncontrolled inflammation in the tumor microenvironment. Several markers have been developed in this regard, including the recent pan-immune-inflammation value (PIV) that incorporates the levels of blood neutrophil, monocyte, platelet, and lymphocytes. In this paper, we reviewed the association between PIV and overall survival or progression-free survival in cancer from the published studies to date. We observed that higher PIV levels were an adverse prognostic factor consistently across several clinical scenarios, including non-metastatic or metastatic disease and treatment with targeted therapy or immunotherapy. In contrast, the data were limited in patients treated with chemotherapy or patients with non-metastatic disease. The available evidence demonstrates that PIV could be a readily available biomarker for prognosis prediction in cancer. However, further research is needed to explore the promise of PIV as a prognostic biomarker in cancer. Background: Prognostic scores derived from the blood count have garnered significant interest as an indirect measure of the inflammatory pressure in cancer. The recently developed pan-immune-inflammation value (PIV), an equation including the neutrophil, platelet, monocyte, and lymphocyte levels, has been evaluated in several cohorts, although with variations in the tumor types, disease stages, cut-offs, and treatments. Therefore, we evaluated the association between survival and PIV in cancer, performing a systematic review and meta-analysis. Methods: We conducted a systematic review from the Pubmed, Medline, and Embase databases to filter the published studies until 17 May 2022. The meta-analyses were performed with the generic inverse-variance method with a random-effects model. Results: Fifteen studies encompassing 4942 patients were included. In the pooled analysis of fifteen studies, the patients with higher PIV levels had significantly increased risk of death than those with lower PIV levels (HR: 2.00, 95% CI: 1.51-2.64, p < 0.001) and increased risk of progression or death (HR: 1.80, 95% CI: 1.39-2.32, p < 0.001). Analyses were consistent across several clinical scenarios, including non-metastatic or metastatic disease, different cut-offs (500, 400, and 300), and treatment with targeted therapy or immunotherapy (p < 0.001 for each). Conclusion: The available evidence demonstrates that PIV could be a prognostic biomarker in cancer. However, further research is needed to explore the promise of PIV as a prognostic biomarker in patients with non-metastatic disease or patients treated without immunotherapy or targeted therapy.