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Elevated pretreatment pan-immune-inflammation value correlates with worse survival outcomes in patients treated with immune checkpoint inhibitorsHigh inflammation levels may signal poorer survival for cancer patients

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Key Takeaway
Note that elevated pretreatment PIV may serve as an adverse prognostic biomarker for survival in patients receiving ICIs.

This systematic review and meta-analysis evaluated the predictive value of pretreatment pan-immune-inflammation value (PIV) in patients with solid malignancies treated with immune checkpoint inhibitors. The analysis included 3,272 participants across 28 cohorts to assess survival outcomes.

The meta-analysis found that elevated PIV was significantly associated with shorter overall survival (HR 2.31; 95% CI: 2.02-2.65; P < 0.00001). Additionally, higher PIV levels were associated with inferior disease-free survival, progression-free survival, and recurrence-free survival (HR 1.79; 95% CI: 1.42-2.26; P < 0.00001).

The authors note that the predictive performance of PIV for DFS, PFS, and RFS may have been influenced by several factors, including follow-up duration, geographic region, specific PIV cutoff definitions, and varying cancer types. While the association is statistically significant, causality is not established.

Clinically, elevated pretreatment PIV may serve as a potentially useful adverse prognostic biomarker for survival outcomes in patients receiving ICIs. However, it is not currently considered a definitive diagnostic or prognostic tool.

How this fits prior evidence

This meta-analysis addresses a gap in identifying specific biomarkers to predict outcomes in patients with solid malignancies treated with immune checkpoint inhibitors. While prior coverage noted limited activity of ICIs in unselected pancreatic ductal adenocarcinoma and improved survival for certain combinations in small-cell lung cancer, this study provides a broader look at PIV as a prognostic indicator across various solid tumors.

When doctors treat solid tumors with immune checkpoint inhibitors, they want to know which patients will respond best. A large review of 3,272 patients across 28 different groups looked at a specific marker called the pan-immune-inflammation value, or PIV. This score measures how much inflammation is happening in the body before treatment starts.

The data showed that patients with a high PIV score had significantly shorter overall survival times. These same patients also saw worse results in other categories, such as disease-free and progression-free survival. Essentially, a high inflammation score was linked to a harder road ahead for those undergoing these specific immunotherapies.

While the link is clear, there are some things to keep in mind. Because the study included many different types of cancer and various follow-up times, the exact predictive power might vary depending on the specific type of cancer or where the patient lives. It is a helpful tool for doctors to understand risks, but it is not a definitive diagnostic test.

What this means for you:
High pre-treatment inflammation levels are linked to shorter survival in patients using immune checkpoint inhibitors.

Common questions

What is the PIV score?

PIV stands for pan-immune-inflammation value. It is a measurement taken before treatment begins to look at inflammation levels in the body. In this study, a higher PIV score was linked to shorter overall survival and worse outcomes for patients with solid tumors treated with immune checkpoint inhibitors.

How does high inflammation affect cancer treatment?

Patients with an elevated PIV score showed significantly lower rates of disease-free, progression-free, and recurrence-free survival. The data suggests that high levels of inflammation before starting treatment are associated with a harder outlook for patients receiving immune checkpoint inhibitors.

Is this test reliable for every type of cancer?

The study included 3,272 participants across many different groups. However, because it covered various cancer types and regions, the exact predictive power of the PIV score might change depending on the specific type of cancer or the length of follow-up time.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
ObjectiveImmune checkpoint inhibitors (ICIs) show substantial therapeutic potential in advanced or metastatic solid malignancies, yet optimization of clinical benefit remains an unmet need. This systematic review and meta-analysis evaluates the pretreatment pan-immune-inflammation value (PIV) as a prognostic biomarker in ICI-treated solid tumors.MethodsWe conducted comprehensive searches in PubMed, EMBASE, Cochrane Library and Web of Science covering all records available up to January 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) were retrieved, and pooled analyses were performed using STATA 18.0 to quantify correlations between PIV and survival results. Overall survival (OS) was considered the primary outcome, with disease-free, progression-free, and recurrence-free survival (DFS/PFS/RFS) as secondary endpoints.ResultsTwenty-two studies comprising 28 cohorts and 3,272 participants were incorporated. Multivariate meta-analysis detected that an elevated PIV was related to shorter OS (HR = 2.31; 95% CI: 2.02–2.65; P < 0.00001) and inferior DFS/PFS/RFS (HR = 1.79; 95% CI: 1.42–2.26; P < 0.00001). Subgroup analyses denoted that follow-up duration, geographic region, PIV cutoff definitions, and cancer type may have modified the predictive performance of PIV for DFS/PFS/RFS.ConclusionsAmong patients receiving ICIs, an elevated pretreatment PIV may serve as a potentially useful adverse prognostic biomarker for survival outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261290575.
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