Diamantis I Tsilimigras1, Dimitrios Moris1, Rittal Mehta1, Anghela Z Paredes1, Kota Sahara1, Alfredo Guglielmi2, Luca Aldrighetti3, Matthew Weiss4, Todd W Bauer5, Sorin Alexandrescu6, George A Poultsides7, Shishir K Maithel8, Hugo P Marques9, Guillaume Martel10, Carlo Pulitano11, Feng Shen12, Olivier Soubrane13, Bas G Koerkamp14, Itaru Endo15, Timothy M Pawlik16. 1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milano, Italy. 4. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 5. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 6. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 7. Department of Surgery, Stanford University, Stanford, CA, USA. 8. Department of Surgery, Emory University, Atlanta, GA, USA. 9. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 10. Department of Surgery, University of Ottawa, Ottawa, Canada. 11. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 12. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 15. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 16. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: The objective of this study was to examine whether the systemic immune inflammation index (SII) was associated with prognosis among patients following resection of intrahepatic cholangiocarcinoma (ICC). METHODS: The impact of SII on overall (OS) and cancer-specific survival (CSS) following resection of ICC was assessed. The performance of the final multivariable models that incorporated inflammatory markers (i.e. neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR] and SII [platelets∗NLR]) was assessed using the Harrell's concordance index. RESULTS: Patients with high SII had worse 5-year OS (37.7% vs 46.6%, p < 0.001) and CSS (46.1% vs 50.1%, p < 0.001) compared with patients with low SII. An elevated SII (HR = 1.70, 95% CI 1.23-2.34) and NLR (HR = 1.58, 95% CI 1.10-2.27) independently predicted worse OS, whereas high PLR (HR = 1.17, 95% CI 0.85-1.60) was no longer associated with prognosis. Only SII remained an independent predictor of CSS (HR = 1.55, 95% CI 1.09-2.21). The SII multivariable model outperformed models that incorporated PLR and NLR relative to OS (c-index; 0.696 vs 0.689 vs 0.692) and CSS (c-index; 0.697 vs 0.689 vs 0.690). CONCLUSION: SII independently predicted OS and CSS among patients with resectable ICC. SII may be a better predictor of outcomes compared with other markers of inflammatory response among patients with resectable ICC.
BACKGROUND: The objective of this study was to examine whether the systemic immune inflammation index (SII) was associated with prognosis among patients following resection of intrahepatic cholangiocarcinoma (ICC). METHODS: The impact of SII on overall (OS) and cancer-specific survival (CSS) following resection of ICC was assessed. The performance of the final multivariable models that incorporated inflammatory markers (i.e. neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR] and SII [platelets∗NLR]) was assessed using the Harrell's concordance index. RESULTS: Patients with high SII had worse 5-year OS (37.7% vs 46.6%, p < 0.001) and CSS (46.1% vs 50.1%, p < 0.001) compared with patients with low SII. An elevated SII (HR = 1.70, 95% CI 1.23-2.34) and NLR (HR = 1.58, 95% CI 1.10-2.27) independently predicted worse OS, whereas high PLR (HR = 1.17, 95% CI 0.85-1.60) was no longer associated with prognosis. Only SII remained an independent predictor of CSS (HR = 1.55, 95% CI 1.09-2.21). The SII multivariable model outperformed models that incorporated PLR and NLR relative to OS (c-index; 0.696 vs 0.689 vs 0.692) and CSS (c-index; 0.697 vs 0.689 vs 0.690). CONCLUSION: SII independently predicted OS and CSS among patients with resectable ICC. SII may be a better predictor of outcomes compared with other markers of inflammatory response among patients with resectable ICC.
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