# Improving Prognostic Prediction in Head and Neck Cancer Through a Combined Systemic Immune-Inflammation Index and Prognostic Nutritional Index Score

## TL;DR

This study shows that combining two blood test measures can better predict outcomes for head and neck cancer patients before surgery.

## Contribution

The novel contribution is a combined score (coSII–PNI) that improves prognostic accuracy compared to individual inflammation and nutritional indices.

## Key findings

- Patients with a high coSII–PNI score had significantly better disease-free and overall survival.
- The coSII–PNI score showed higher predictive accuracy (AUC 0.730) than SII (0.649) or PNI (0.717) alone.
- The score is a practical preoperative biomarker for risk stratification in head and neck cancer.

## Abstract

Head and neck cancer is often treated with surgery, but some patients still relapse or die even after treatment that is meant to cure them. Surgeons need a simple way to spot patients at higher risk before the operation so that they can provide extra support, such as nutritional care and closer follow-up. We looked at two measures that can be taken from routine blood tests before surgery: one that reflects levels of inflammation in the body and another that reflects nutritional and immune health. We combined these two measures into a single score and tested it in patients with head and neck cancer who had surgery at our hospital. Patients with an unfavorable score were more likely to die or have the cancer return. This simple blood test may help doctors identify susceptible patients early and better plan care and follow-up.

This study evaluated whether a composite index combining the systemic immune–inflammation index (SII) and prognostic nutritional index (PNI), the coSII–PNI score, enhances prognostic prediction in head and neck cancer. We retrospectively evaluated 166 patients who underwent curative surgery between 2015 and 2023. Patients were stratified into three groups according to the coSII–PNI score (range, 0–2) derived from preoperative blood data. The optimal cutoff values for SII and PNI were 743 and 49, respectively. A significant correlation was observed between the SII and PNI (r = −0.386, p < 0.01). Patients with a high coSII–PNI score (low SII + high PNI) showed significantly better disease-free and overall survival than those with lower scores (both p < 0.01). The areas under the curve for predicting prognosis were 0.649 for SII, 0.717 for PNI, and 0.730 for the coSII–PNI score. These findings indicate that integrating systemic inflammation and nutritional status improves prognostic accuracy compared with either index alone. Therefore, the coSII–PNI score may serve as a simple, practical preoperative biomarker for risk stratification in patients with head and neck cancer.