| Summary: | Summary: The systemic immune-inflammation index (SII), derived from platelet, neutrophil, and lymphocyte counts in peripheral blood, is linked to prognosis in several cancers. We evaluated whether changes in SII during neoadjuvant therapy could predict treatment outcomes in gastric cancer. A total of 410 patients received either chemotherapy alone or chemotherapy combined with immune checkpoint inhibitors, including internal and external cohorts. The SII rate (SIIR) was defined as the relative change in SII before and after treatment. Patients with at least a 35% reduction were classified as the SIIR reduction group. In the immunotherapy cohort, patients with SIIR reduction had higher 3-year overall survival and disease-free survival, which was confirmed in the external cohort. Joint model analysis showed that a higher log(SII) was associated with increased mortality risk. No survival differences by SIIR were observed in the chemotherapy-only cohort. These findings suggest SIIR may help identify patients likely to benefit from neoadjuvant immunotherapy.
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