{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:22Z","timestamp":1787028922594,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: With the greatest rate of morbidity and death, OSCC is one of the world\u2019s most critical public health problems. Being a complex pathology, the management process that includes diagnostic, surgical, and adjuvant treatments must as well take into account the involvement of the immune system. This study aims to evaluate various biomarkers such as neutrophils, lymphocytes, platelets, SII, and NLR in the different stages of OSCC treatment and in correlation with TNM stages, in order to observe the inflammatory response of the host. Materials and Methods: A total of 154 patients diagnosed with OSCC were included in the present retrospective study. Routine blood samples were collected from all patients both before and after surgery. Using the detected values of platelets, neutrophils, and lymphocyte count, the systemic immune\u2013inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) were calculated. Based on the oncologist\u2019s recommendation, 46 patients underwent adjuvant radiotherapy as part of their oncologic treatment plan. For these patients, additional blood samples were collected before the first and after the last radiotherapy session for determining the values of platelets, neutrophils, and lymphocyte count, and SII and NLR calculation. Results: Prior to the first radiotherapy session, neutrophils decreased slightly to 4.35, lymphocytes increased to 2.23, and platelets rose to 258.62. The SII and NLR were 641.02 and 2.19, respectively. Following the last radiotherapy session, neutrophils increased substantially to 10.30, while lymphocytes decreased to 1.21. Platelets showed a slight reduction to 227.08. Notably, the SII rose dramatically to 3084.19, and the NLR increased significantly to 15.49, suggesting an important immune and inflammatory response of the host. Conclusions: The host\u2019s immunological and inflammatory responses are impacted by both surgery and adjuvant radiation administered following surgery. The parameters assessed\u2014neutrophils, lymphocytes, platelets, SII, and NLR\u2014qualify as significant variables that need to be monitored before, during, and following OSCC therapy. This study\u2019s findings validated significant changes in immunological and inflammatory markers in the management of OSCC.<\/jats:p>","DOI":"10.3390\/medicina60111840","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T03:53:14Z","timestamp":1731383594000},"page":"1840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Systemic Immune\u2013Inflammatory Index and Other Inflammatory Marker Variations in Oral Squamous Cell Carcinoma Management"],"prefix":"10.3390","volume":"60","author":[{"given":"Adrian","family":"Nicoar\u0103","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Oral Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3214-9278","authenticated-orcid":false,"given":"Ciprian","family":"Roi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Oral Surgery, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4790-4560","authenticated-orcid":false,"given":"Alexandra","family":"Roi","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru C\u0103t\u0103lin","family":"Motofelea","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Rakitovan","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Zar\u0103","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-1064","authenticated-orcid":false,"given":"Mircea","family":"Rivi\u0219","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Oral Surgery, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-Morales, A., Gonz\u00e1lez-L\u00f3pez, B.S., Scougall-Vilchis, R.J., Bermeo-Escalona, J.R., Vel\u00e1zquez-Enr\u00edquez, U., Islas-Zaraz\u00faa, R., M\u00e1rquez-Rodr\u00edguez, S., Sosa-Velasco, T.A., Medina-Sol\u00eds, C.E., and Maupom\u00e9, G. (2023). Lip and Oral Cavity Cancer Incidence and Mortality Rates Associated with Smoking and Chewing Tobacco Use and the Human Development Index in 172 Countries Worldwide: An Ecological Study 2019\u20132020. Healthcare, 11.","DOI":"10.3390\/healthcare11081063"},{"key":"ref_2","unstructured":"International Agency for Research on Cancer (2020). GLOBOCAN 2020: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2020, IARC. Available online: http:\/\/globocan.iarc.fr\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sofi-Mahmudi, A., Masinaei, M., Shamsoddin, E., Tovani-Palone, M.R., Heydari, M.H., Shoaee, S., Ghasemi, E., Azadnajafabad, S., Roshani, S., and Rezaei, N. (2021). Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: A systematic analysis of the Global Burden of Disease Study 1990\u20132017. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01918-0"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.47162\/RJME.61.4.22","article-title":"Oral cancer histopathological subtypes in association with risk factors: A 5-year retrospective study","volume":"61","author":"Roi","year":"2020","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zhang, J., and Dai, S. (2024). Prognostic and clinicopathological role of pretreatment systemic immune-inflammation index in patients with oral squamous cell carcinoma: A meta-analysis. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1303132"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Barsouk, A., Aluru, J.S., Rawla, P., Saginala, K., and Barsouk, A. (2023). Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma. Med. Sci., 11.","DOI":"10.3390\/medsci11020042"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wang, Y.T., Kuo, L.T., Weng, H.H., Hsu, C.M., Tsai, M.S., Chang, G.H., Lee, Y.C., Huang, E.I., and Tsai, Y.T. (2022). Systemic Immun e-Inflammation Index as a Predictor for Head and Neck Cancer Prognosis: A Meta-Analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.899518"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bellantoni, M., Picciolo, G., Pirrotta, I., Irrera, N., Vaccaro, M., Vaccaro, F., Squadrito, F., and Pallio, G. (2023). Oral Cavity Squamous Cell Carcinoma: An Update of the Pharmacological Treatment. Biomedicines, 11.","DOI":"10.3390\/biomedicines11041112"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Mu, G., Wang, J., Liu, Z., Zhang, H., Zhou, S., Xiang, Q., and Cui, Y. (2021). Association between smokeless tobacco use and oral cavity cancer risk in women compared with men: A systematic review and meta-analysis. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08691-x"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jcms.2017.10.019","article-title":"The localization and risk factors of squamous cell carcinoma in the oral cavity: A retrospective study of 1501 cases","volume":"46","author":"Sundermann","year":"2018","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/S1470-2045(12)70137-7","article-title":"Global burden of cancers attributable to infections in 2008: A review and synthetic analysis","volume":"13","author":"Ferlay","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2358","DOI":"10.1016\/j.joms.2021.06.023","article-title":"Novel Prediction Models for Patients With Oral Squamous Cell Carcinoma at Different Anatomical Sites","volume":"79","author":"Liu","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kubota, K., Ito, R., Narita, N., Tanaka, Y., Furudate, K., Akiyama, N., Chih, C.H., Komatsu, S., and Kobayashi, W. (2022). Utility of prognostic nutritional index and systemic immune-inflammation index in oral cancer treatment. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09439-x"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Staniewska, E., Grudzien, K., Stankiewicz, M., Raczek-Zwierzycka, K., Rembak-Szynkiewicz, J., Nowicka, Z., Tarnawski, R., and Miszczyk, M. (2024). The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy. Cancers, 16.","DOI":"10.3390\/cancers16081542"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12329","DOI":"10.2147\/CMAR.S277927","article-title":"Inflammatory Marker Predicts Outcome of Oral Squamous Cell Carcinoma Receiving Chemo-Radiotherapy","volume":"1","author":"Sun","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/s41392-021-00658-5","article-title":"Inflammation and tumor progression: Signaling pathways and targeted intervention","volume":"6","author":"Zhao","year":"2021","journal-title":"Sig Transduct. Target. Ther."},{"key":"ref_18","first-page":"173","article-title":"Tumor-associated macrophages and neutrophils in tumor microenvironment","volume":"35","author":"Kim","year":"2016","journal-title":"Mediat. Inflamm."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yin, X., Zhang, Y., Zou, J., and Yang, J. (2024). Association of the systemic immune-inflammation index with all-cause and cardiovascular mortality in individuals with rheumatoid arthritis. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-66152-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1111\/odi.13049","article-title":"Preoperative circulating platelet, neutrophil, and lymphocyte counts predict survival in oral cancer","volume":"25","author":"Diao","year":"2019","journal-title":"Oral Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1002\/hed.25580","article-title":"Preoperative neutrophil lymphocyte ratio but not platelet lymphocyte ratio predicts survival and early relapse in patients with oral, pharyngeal, and lip cancer","volume":"41","author":"Yu","year":"2019","journal-title":"Head Neck"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Roi, C.I., Roi, A., Nicoar\u0103, A., Nica, D., Rusu, L.C., Soanc\u0103, A., Motofelea, A.C., and Rivi\u0219, M. (2023). Impact of Treatment on Systemic Immune-Inflammatory Index and Other Inflammatory Markers in Odontogenic Cervicofacial Phlegmon Cases: A Retrospective Study. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061710"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e34596","DOI":"10.1097\/MD.0000000000034596","article-title":"Systemic immune-inflammation index: A new marker in differentiation of different thyroid diseases","volume":"102","author":"Vural","year":"2023","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e13230","DOI":"10.1111\/eci.13230","article-title":"Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease","volume":"50","author":"Yang","year":"2020","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lu, Z., Yan, W., Liang, J., Yu, M., Liu, J., Hao, J., Wan, Q., Liu, J., Luo, C., and Chen, Y. (2020). Nomogram based on systemic immune-inflammation index to predict survival of tongue cancer patients who underwent cervical dissection. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.00341"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"75381","DOI":"10.18632\/oncotarget.18856","article-title":"Prognostic role of systemic immune-inflammation index in solid tumors: A systematic review and meta-analysis","volume":"8","author":"Zhong","year":"2017","journal-title":"Oncotarget"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3295","DOI":"10.7150\/jca.25691","article-title":"Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis","volume":"9","author":"Yang","year":"2018","journal-title":"J. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.2147\/DMSO.S437580","article-title":"Exploring the Correlation Between the Systemic Immune Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Type 2 Diabetic Retinopathy","volume":"16","author":"Wang","year":"2023","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1102\/1470-7330.2007.0013","article-title":"What\u2019s new in target volume definition for radiologists in ICRU Report 71? How can the ICRU volume definitions be integrated in clinical practice?","volume":"7","author":"Berthelsen","year":"2007","journal-title":"Cancer Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1186\/s12967-018-1742-x","article-title":"Preoperative systemic immune-inflammation index predicts prognosis of patients with oral squamous cell carcinoma after curative resection","volume":"16","author":"Diao","year":"2018","journal-title":"J. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rakitovan, M., Nicoara, A., Closca, R.M., Balica, N.C., Stefanescu, E.H., and Baderca, F. (2023). Leiomyoma with Uncommon Localization\u2014Incisive Papilla and Palatal Fibromucosa: A Case Report. Medicina, 59.","DOI":"10.20944\/preprints202306.1182.v1"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wang, Q., Tan, X., Deng, G., Fu, S., Li, J., and Li, Z. (2022). Dynamic changes in the systemic immune-inflammation index predict the prognosis of EGFR-mutant lung adenocarcinoma patients receiving brain metastasis radiotherapy. BMC Pulm. Med., 22.","DOI":"10.1186\/s12890-022-01866-7"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2910892","DOI":"10.1155\/2021\/2910892","article-title":"The Value of the Systemic Immune-Inflammation Index in Predicting Survival Outcomes in Patients with Brain Metastases of Non-Small-Cell Lung Cancer Treated with Stereotactic Radiotherapy","volume":"2021","author":"Zhang","year":"2021","journal-title":"Mediat. Inflamm."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1038\/s41416-020-01106-x","article-title":"Prognostic significance of pre-treatment neutrophil-to-lymphocyte ratio (NLR) in patients with oropharyngeal cancer treated with radiotherapy","volume":"124","author":"Ng","year":"2021","journal-title":"Br. J. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.radonc.2019.01.032","article-title":"Pre-treatment neutrophil-lymphocyte ratio is associated with overall mortality in localized non-small cell lung cancer treated with stereotactic body radiotherapy","volume":"134","author":"Sebastian","year":"2019","journal-title":"Radiother. Oncol."},{"key":"ref_36","unstructured":"Edge, S.B., Byrd, D.R., Compton, C.C., Fritz, A.G., Greene, F.L., and Trotti, A. (2010). AJCC Cancer Staging Manual, Springer. [7th ed.]."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Yin, X., Chen, H., Sun, Y., Xiao, L., Lu, H., Guo, W., Yang, H., Zhou, J., Fan, K., and Liang, W. (2024). Prognostic value of neutrophil-to-lymphocyte ratio change in patients with locally advanced non-small cell lung cancer treated with thoracic radiotherapy. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-62662-3"},{"key":"ref_38","first-page":"25","article-title":"Predictive value of systemic immune-inflammation index combined with clinical staging for prognosis of esophageal cancer patients","volume":"12","author":"Yan","year":"2022","journal-title":"Chin. J. Radiol. Med. Prot."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Closca, R.-M., Nicoara, A., Rakitovan, M., Mot, I.C., and Baderca, F. (2023). Unpredictable Metastasis in the Head and Neck Region: A Diagnostic Immunohistochemical Challenge. Diagnostics, 13.","DOI":"10.20944\/preprints202310.0207.v1"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Bal\u00e1zs, K., Kis, E., Badie, C., Bogd\u00e1ndi, E.N., Cand\u00e9ias, S., Garcia, L.C., Dominczyk, I., Frey, B., Gaipl, U., and Jur\u00e1nyi, Z. (2019). Radiotherapy-Induced Changes in the Systemic Immune and Inflammation Parameters of Head and Neck Cancer Patients. Cancers, 11.","DOI":"10.3390\/cancers11091324"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Antonelli, A., Battaglia, A.M., Sacco, A., Petriaggi, L., Giorgio, E., Barone, S., Biamonte, F., and Giudice, A. (2024). Ferroptosis and oral squamous cell carcinoma: Connecting the dots to move forward. Front. Oral Health., 5.","DOI":"10.3389\/froh.2024.1461022"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Cho, U., Sung, Y.-E., Kim, M.-S., and Lee, Y.-S. (2022). Prognostic Role of Systemic Inflammatory Markers in Patients Undergoing Surgical Resection for Oral Squamous Cell Carcinoma. Biomedicines, 10.","DOI":"10.3390\/biomedicines10061268"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3263","DOI":"10.1002\/hed.26375","article-title":"Prognostic value of preoperative systemic inflammation response index in patients with oral squamous cell carcinoma: Propensity score-based analysis","volume":"42","author":"Lin","year":"2020","journal-title":"Head Neck"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.2147\/IJGM.S458666","article-title":"Correlation of Prognostic Nutritional Index and Systemic Immune-Inflammation Index with the Recurrence and Prognosis in Oral Squamous Cell Carcinoma with the Stage of III\/IV","volume":"17","author":"Ye","year":"2024","journal-title":"Int. J. Gen. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1840\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:28:57Z","timestamp":1760113737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,8]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111840"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111840","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,8]]}}}