“The pan-immune-inflammation value (PIV) is a recently proposed scoring system that includes all immune-inflammatory cells in the peripheral blood count (neutrophil count × platelet count × monocyte count)/lymphocyte count). A total of 114 patients were included in this study. At the median follow-up of 34.6 months (95% confidence interval [CI]: 32.4-36.8), the median OS was 21 months (95% CI: 17.6-21.3). The median OS in the low-PIV group was significantly higher than in the high-PIV group (34.4 months (95% CI: 21.3-47.5) vs. 14.3 months (95% CI: 10.0-18.7), p < 0.001). In the multivariate analysis for OS, high PIV (hazard ratio [HR]: 1.86, 95% CI: 1.11-3.13, p = 0.018) and LDH value 1.5 times the upper limit of normal and above (HR: 3.65 95%, CI: 1.86-7.16, p < 0.001) were associated with shorter OS. When survival analysis was performed according to the PIV-LDH combined score, the median OS was 34.4 months (95% CI: 22.2-46.6) in the low-risk group, 17.7 months (95% CI: 11.7-23.6) in the intermediate-risk group, and 8.4 months (95% CI: 5.1-11.7) in the high-risk group (p < 0.001). The C-index of the combined PIV-LDH score was higher than the C-index of PIV (0.65 vs. 0.61)."
I was able to access the full study starting with the link above, but today I am not able to get beyond the pay wall.
The authors did not give the cutoff PIV value–they just divided patients into two equal halves. My PIV range over ten tests in the last three years has been 69 to 255, average 122. I would be pleased if anyone else could volunteer some numbers so we could get a sense of what the range looks like.
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Thank you. That study says the “optimal cut-off values” for certain variables includes >=306.4 for PIV which maybe means they use that as their dividing point between the two groups [of those responding well 81.8% had lower PIVs, of those not responding well 54.2% had lower PIVs]? In that study I do not see the chart you included--was it from somewhere else? And not clear to me what “Days” represents in that chart.
The most probable cause is the units used. NLR (Neutrofils to Lymphocytes Ratio) is a pure number, irrespective of units used, as they are the same on the nominator and the denominator. This is not true with PIV as the nominator has kcells/ul to the 3rd power (from the product of NeutrofilsxLymphocytesxMonocytes) while the denominator is kcels/ul to the 1st (from Platelets). So, depending on the unit used the result can differ due to the latter raised to the square that remains.
It seems you are using the percentage values for all but the Platelets. You should be using the absolute values which are much smaller. If your report doesn't include them then they can be calculated from your WBC (devide your number by 10000 to make the percentages to decimals and multiply by your WBC in kcells/ul raised to the 3rd). One example: Normal range for Neutrofils in kcells/ul is 1.90 - 8.00, or thereabout depending on lab.
#8, 9, 16, and 23 are not cancer. Several Turkish studies may affect the PIV values (maybe standard PIVs differ significantly by country (level of economic development and such).
Median PIVcutoffs are not given in most of these abstracts, and they are based on those already diagnosed with cancer. The median values where given are 209, 372, 310.2, 372, 376, 306.4 (and 100, which I reject as an outlier, or maybe I did not understand).
The only study referencing prostate cancer:
Prognostic role of pan-immune-inflammation value in patients with metastatic castration-resistant prostate cancer treated with androgen receptor-signaling inhibitors
“The median OS in the low-PIV group was significantly higher than in the high-PIV group (34.4 months (95% CI: 21.3-47.5) vs. 14.3 months (95% CI: 10.0-18.7), p < 0.001)”
The other, cancer-related studies follow:
Pan-immune-inflammation value is associated with the clinical stage of colorectal cancer
A decreased preoperative platelet-to-lymphocyte ratio, systemic immune-inflammation index, and pan-immune-inflammation value are associated with the poorer survival of patients with a stent inserted as a bridge to curative surgery for obstructive colorectal cancer
“In the pooled analysis of fifteen studies, the patients with higher PIV levels had significantly increased risk of death than those with lower PIV levels (HR: 2.00, 95% CI: 1.51-2.64, p < 0.001) and increased risk of progression or death (HR: 1.80, 95% CI: 1.39-2.32, p < 0.001).”
The relationship between pan-immune-inflammation value and survival outcomes in patients with metastatic renal cell carcinoma treated with nivolumab in the second line and beyond: a Turkish oncology group kidney cancer consortium (TKCC) study
“According to cut-off value for PIV, 77 (50.7%) and 75 (49.3%) patients fell into PIV-low ([Formula: see text] 372) and PIV-high (> 372) groups, respectively. In multivariate analysis, PIV-high (HR: 1.64, 95% CI 1.04-2.58, p = 0.033 for overall survival (OS); HR: 1.55, 95% CI 1.02-2.38, p = 0.042 for progression-free survival (PFS)) was independent risk factor for OS and PFS after adjusting for confounding variables, such as performance score, the International mRCC Database Consortium (IMDC) risk score, and liver metastasis.”
Pan-Immune-Inflammation Value: A New Prognostic Index in Operative Breast Cancer
“According to the best cutoff value of PIV, we divided the patients into two different subgroups, high PIV (PIV > 310.2) and low PIV (PIV = 310.2), associated with significantly different survival outcomes (3-year OS, 80.26% vs. 86.29%, respectively; 5-year OS, 62.5% vs. 71.55%, respectively).”
Clinical significance of baseline Pan-Immune-Inflammation Value and its dynamics in metastatic colorectal cancer patients under first-line chemotherapy
“Baseline PIV high was significantly associated with worse OS in univariate [hazard ratio (HR) = 2.10, 95% CI, 1.41-3.15; p = 0.000299] and multivariate (HR = 1.82, 95% CI, 1.15-2.90; p = 0.011) analyses.”
Not possible to make an accurate guess at the PIV cutoff in the charts presented.
Pan-immune-inflammation value independently predicts disease recurrence in patients with Merkel cell carcinoma
“ROC [Receiver Operating Characteristic, I think} analysis revealed that MCC [Merkel cell carcinoma] recurrence was significantly associated with a PIV greater than 372 [p < 0.0001, Youden index 0.58; hazard ratio: 4 (95% confidence interval: 1.7 to 9.2)]. In multivariate analysis, only a PIV greater than 372 and higher MCC stage were determined as independent predictors for disease recurrence.”
The preoperative pan-immune-inflammation value is a novel prognostic predictor for with stage I-III colorectal cancer patients undergoing surgery
“The Kaplan-Meier method and log-rank test showed significant differences in overall survival between patients with stage I-III disease with high (> 376) and low (= 376) PIVs.”
The pan-immune-inflammation value and systemic immune-inflammation index in advanced melanoma patients under immunotherapy
“PIV and SII seem not to be significant predictors for clinical outcome measures of CM patients under ICI therapy.”
The Pan-Immune-Inflammation Value predicts the survival of patients with anaplastic lymphoma kinase-positive non-small cell lung cancer treated with first-line ALK inhibitor
I believe there is a misprint in the results paragraph, resulting in the PIV value being omitted.
PIV and PILE Score at Baseline Predict Clinical Outcome of Anti-PD-1/PD-L1 Inhibitor Combined With Chemotherapy in Extensive-Stage Small Cell Lung Cancer Patients
“Patients in the low PIV group (PIV < median) had longer progression-free survival (PFS) and overall survival (OS) than those in the high PIV group (PIV = median), along with the HR, which was 2.157 and 2.359, respectively (PFS HR 95% CI: 1.181-3.940, p = 0.012; OS HR 95% CI: 1.168-4.762, p = 0.020)”
Low pan-immune-inflammation-value predicts better chemotherapy response and survival in breast cancer patients treated with neoadjuvant chemotherapy
“Based on our results, pre-treatment PIV seems as a predictor for pCR and survival, outperforming NLR, MLR, PLR in predicting pCR in Turkish women with breast cancer. . . .”
The Pan-Immune-Inflammation Value in Patients with Metastatic Melanoma Receiving First-Line Therapy
“High baseline PIV was independently associated with poor overall survival (adjusted hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.30-3.29; adjusted P = 0.002) and progression-free survival (adjusted HR 1.56; 95% CI 1.01-2.41; adjusted P = 0.044). High PIV was also associated with primary resistance to both immunotherapy (odds ratio [OR]: 3.98; 95% CI 1.45-12.32; P = 0.005) and targeted therapy (OR: 8.42; 95% CI 2.50-34.5; P < 0.001). “
The Pan-Immune-Inflammation-Value Predicts the Survival of Patients with Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Advanced Breast Cancer Treated with First-Line Taxane-Trastuzumab-Pertuzumab
“Regarding OS, both high PIV and MLR [monocyte to lumphocite ratio] were associated with significantly worse patient survival at univariate analysis, but only the PIV was statistically significantly associated with worse overall survival at multivariable analysis (HR 7.96; 95% CI: 2.18-29.09). “
The Pan-Immune-Inflammation Value in microsatellite instability-high metastatic colorectal cancer patients treated with immune checkpoint inhibitors
Trying to find some meaningful cutoff point is futile. One is led to this conclusion by merely calculating the most probable value of PIV among the general population. According to one of my labs, Neutrophils NR (normal range) = 2.5-7.5 -> CV (centre value) 5.0, Platelets NR = 150-400 -> CV 275, Monocytes NR = 0.2-0.8 -> CV 0.5 and Lymphocytes NR = 1.5-3.5 CV 2.5, all in kcells/μL. Use these centre values, bearing the highest probability density, to end up with a nice PIV = 275. Values like 300 and 310 are too close to 275 to denote any notable difference. That is the reason, in my case, I didn't post a naked number but a time series synced to my PCa progression/treatment. The latter may have some usefulness, the former none. Same story as with PSA and PSADT.
Traveling now to backpack in Grand Tetons and Yellowstone. I wrote an analysis of the various cutoff values used in studies of Pan-Immune- Inflammation Value (PIV) and also other blood cell rations (Neutrophil to Lymphocyte and Platelet to lymphocyte). I don't have the breakdown of the cutoff values to define High vs Low. And decided to not post it as it can drive you crazy trying to sort out if you are "good" or not.
So here is my view. Most of the white blood cells, especially neutrophils are there to respond to immediate threats such as infections (acute or chronic) and are tangled up in the beneficial inflammatory processes to fight and contain infection. Monocytes are also involved in these battles with longer term viral infections. And platelets are also affected by the demands of inflammation in the blood vessels. So higher levels of these are indications of active inflammation, including even low grade infections. (Think gastrointestinal. Think dental and gums, etc.)
Lymphocytes do many things but generally may be considered the guardians of immunity among other things. So when Lymphocytes are high and Neutrophils (as well as Monocytes, and platelets are low), it suggests a profile where "Pan-Inflammation" is low, in a positive balance. Another marker of overall inflammation is the C-Reactive Protein test. We would like to see this as low as possible.
The question is: What do we actually do about it, if we know that ongoing even low levels of inflammation are detrimental? Bad for our longevity. Bad for our mitochondria and energy metabolism. And bad for prostate cancer, as well as other cancers.
First off, we identify and correct any obvious or even occult sources of ongoing infection. Get our teeth and gums in shape. We eat a good balance of foods including those plant based sources of beneficial phyto-chemicals. The colored veggies especially. And berries. I am not adverse to supplementing with certain beneficial natural phytochemicals . (Such as Sulforaphane, Fisetin, Quercetin, Curcumin and a few others. (Much debated here so one must make their own choices and consider risks vs benefits.) Good food with lots of diverse plants included is certainly wise. But one need not be vegetarian.
Exercise, of course! Lots of moderate level endurance renews out mitochondria and staves off frailty and senescence. Reducing inflammation from "leaky" mitochondria in the process. Add in some occasional high intensity intervals (HIIT). And serious strength workouts to maintain the highest possible muscle volume and strength. As best we can for as long as we live. Once a week high intensity strength workout seems to be as beneficial as multiple days. As long it is done at a quite high intensity, it need not take long (but it will be hard.)
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