Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 467-482
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.467
Prognostic significance of systemic immune-inflammation index in patients with intrahepatic cholangiocarcinoma undergoing hepatic resection
Hui Li, Jin-Ju Wang, Min Zhang, Bo Ren, Jia-Xin Li, Lin Xu, Hong Wu
Hui Li, Jin-Ju Wang, Bo Ren, Jia-Xin Li, Lin Xu, Hong Wu, Department of Liver Surgery and Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Hui Li, Jin-Ju Wang, Bo Ren, Jia-Xin Li, Lin Xu, Hong Wu, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu 610041, Sichuan Province, China
Hui Li, Jin-Ju Wang, Bo Ren, Jia-Xin Li, Lin Xu, Hong Wu, Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
Min Zhang, Department of Anesthesiology, Jiulongpo People’s Hospital, Chongqing 400000, China
Author contributions: Li H, Wang JJ and Zhang M contributed equally to this work and should be considered as co-first authors; Li H and Wu H contributed to the designation of this study; Li H and Xu L collected the clinical data; Li H, Wang JJ and Ren B contributed to data analysis; Li H and Li JX performed the statistical analysis; all the authors participated in drafting the manuscript; Li H, Wang JJ and Zhang M revised the manuscript; all the authors approved the final version of manuscript.
Supported by the National Natural Science Foundation of China, No. 81972747, No. 81872004, No. 81800564, No. 81770615, No. 81700555 and No. 81672882; the Science and Technology Support Program of Sichuan Province, No. 2019YFQ0001, No. 2018SZ0115 and No. 2017SZ0003; the Science and Technology Program of Tibet Autonomous Region, No. XZ201801-GB-02; and the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZYJC18008.
Institutional review board statement: This study was approved by Institutional Review Board of the West China Hospital.
Informed consent statement: All patients in our study provided informed consent.
Conflict-of-interest statement: All the authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong Wu, MD, PhD, Professor, Surgeon, Department of Liver Surgery and Liver Transplantation, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. wuhong7801@163.com
Received: December 13, 2019
Peer-review started: December 13, 2019
First decision: February 14, 2020
Revised: March 11, 2020
Accepted: March 26, 2020
Article in press: March 26, 2020
Published online: April 15, 2020
Abstract
BACKGROUND

The prognosis of intrahepatic cholangiocarcinoma (ICC) patients following surgical resection remains poor. It is necessary to investigate effective biomarkers or prognostic models for ICC patients.

AIM

To investigate the prognostic effect of systemic immune-inflammation index (SII) to predict long-term outcomes in ICC patients with undergoing hepatic resection.

METHODS

Consecutive ICC patients who underwent initial hepatectomy with curative intent from January 2009 to September 2017 were retrospectively reviewed. Receiver-operating characteristic (ROC) curves were used to determine the optimal cut-off values of SII. Kaplan-Meier curves and Cox proportional hazards regression were performed to evaluate the discriminative ability of preoperative SII in predicting overall survival (OS) and recurrence-free survival (RFS).

RESULTS

A total of 530 patients were included and randomly divided into derivation (n = 265) and validation cohort (n = 265). The optimal cut-off value for SII was 450. At a median follow-up of 18 mo (range, 1-115.4 mo), 317 (59.8%) patients died and 381 (71.9%) patients experienced tumor relapse. Low SII level was associated with better OS and RFS (both P < 0.05). Multivariate analyses identified multiple tumors, node invasion and high SII level as independent risk factors for OS, while multiple tumors, node invasion and high SII level were identified as independent risk factors for RFS. Validation cohort confirmed the findings of derivation cohort.

CONCLUSION

The present study demonstrated the feasibility of preoperative SII as a prognostic indicator for ICC. Patients with increased SII level were associated with worse OS and earlier tumor recurrence. Elevated SII level was an independent risk factor for OS and RFS in patients with ICC after hepatectomy. In the future, the SII could help stratifying patients with ICC, thus guiding therapeutic choices, especially in immunotherapy.

Keywords: Intrahepatic cholangiocarcinoma, Systemic immune-inflammation index, Hepatectomy, Prognostic predictor, Long-term outcomes, Immunotherapy

Core tip: Inflammation has been reported to play a crucial role in tumor biology. Systemic immune-inflammation index (SII), an inflammation-based index, was a composite measure of neutrophil, platelet and lymphocyte counts. No data exists until now, has evaluated its prognostic value for intrahepatc cholangiocarcinoma (ICC). This study aimed to investigate the clinical significance of preoperative SII levels in ICC patients undergoing curative resection. Patients with increased SII level were associated with worse overall survival and earlier tumor recurrence. In the future, the SII could help stratifying patients with ICC, thus guiding therapeutic choices, especially in immunotherapy.