Background: The aggregate index of systemic inflammation (AISI, calculated as neutrophil count × monocyte count × platelet count/lymphocyte count) reflects systemic inflammatory status; however, its prognostic role in diffuse large B-cell lymphoma (DLBCL) remains underexplored. This study aimed to investigate the prognostic value of AISI in DLBCL. Methods: A total of 1332 DLBCL patients (median age 62 years; 52.3% male) were included in this study. Patients were stratified based on AISI quartiles, and a cut-off value was determined using restricted cubic splines (RCS) analysis. The associations between AISI and Overall survival (OS) were assessed using Kaplan-Meier analysis and Cox proportional hazards models. Results: Higher AISI levels were associated with adverse clinical features, including advanced Ann Arbor stage, poor performance status, and higher-risk categories of both the IPI and the NCCN-IPI. RCS analysis revealed a nonlinear relationship between AISI and OS, with an inflection point at 261.33. Kaplan-Meier analysis demonstrated that patients with AISI > 261.33 had significantly worse OS compared to those with AISI ≤ 261.33 ( P = 0.003). Similarly, patients in the Q4 group had poorer OS than those in the lowest two quartiles (Q1-Q2) ( P = 0.008). In fully adjusted Cox proportional hazards models (adjusted for age, sex, Ann Arbor stage, LDH, ECOG performance status, BMI, albumin, B symptoms, bone marrow involvement, central nervous system involvement, and liver/spleen involvement), high AISI level (> 261.33) were associated with increased mortality risk ( HR = 1.28, 95% CI: 1.04– 1.57, P = 0.018). Subgroup analyses indicated that the prognostic impact of AISI was particularly evident among patients classified as low risk by conventional prognostic systems. Conclusion: Elevated AISI was associated with inferior OS in DLBCL patients and may potentially serve as a prognostic biomarker. Keywords: aggregate index of systemic inflammation, diffuse large B-cell lymphoma, prognosis, risk stratification
Chen et al. (Sun,) studied this question.