# Prognostic value of the pretreatment pan-immune-inflammation value in patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis

## TL;DR

This study finds that a pretreatment immune-inflammation value is linked to worse survival outcomes in head and neck cancer patients.

## Contribution

This is the first systematic review and meta-analysis to evaluate the prognostic role of pretreatment PIV in head and neck squamous cell carcinoma.

## Key findings

- High PIV is associated with significantly worse overall survival in head and neck cancer patients.
- Higher PIV correlates with poorer disease-free and distal metastasis-free survival outcomes.
- PIV shows consistent prognostic value across different regions, tumor stages, and treatment strategies.

## Abstract

The prognostic significance of the pan-immune-inflammation value (PIV) in head and neck squamous cell carcinoma has been comprehensively documented. Nevertheless, its exact role remains ambiguous. The objective of this study is to perform a systematic exploration of the correlation between the pretreatment PIV and survival outcomes in this population.

An extensive and systematic search of the literature was conducted through electronic databases, including Web of Science, PubMed, and Embase. The search period covered from inception to October 1, 2025. The primary endpoint was survival outcomes. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for survival outcomes were retrieved. A random-effects model was employed to integrate the pooled findings. This meta-analysis was prospectively registered with PROSPERO (CRD420251170558).

A total of twelve studies, encompassing 5,056 patients, were included. The pooled results revealed that patients in the high PIV group exhibited significantly inferior overall survival (12 studies; HR = 2.62; 95% CI: 2.00 – 3.44; I² = 74%) and disease-free survival (9 studies; HR = 2.34; 95% CI: 1.69 - 3.26; I² = 79%) when compared to those in the low PIV group. Subgroup analyses buttressed the prognostic significance of PIV for overall survival and disease-free survival across diverse geographical regions, tumor stages, and treatment strategies. Moreover, evidence aggregated from limited studies indicated that a higher PIV was associated with a worse distal metastasis-free survival (3 studies; HR = 2.04; 95% CI: 1.13 - 3.67; P = 0.02; I² = 94%) and a marginally poorer local recurrence-free survival (3 studies; HR = 1.20; 95% CI: 1.00 - 1.44; P = 0.05; I² = 0%).

Our findings indicate that the pretreatment PIV has the potential to serve as a valuable biomarker for predicting the survival outcomes of patients with head and neck squamous cell carcinoma.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251170558.