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
Processing time: 123 Days and 23.8 Hours
ARTICLE HIGHLIGHTS
Research background

Intrahepatic cholangiocarcinoma (ICC) is a subtype of cholangiocarcinoma, representing 15%-20% of all primary liver cancer. The incidence of ICC is increasing over the years. Among all therapeutic strategies for ICC, surgical resection remains the mainstay. However, the prognosis of ICC patients following surgical resection remains poor. Therefore, it is necessary to investigate effective biomarkers or prognostic models for ICC patients following hepatic resection. Inflammation has been reported to play a crucial role in tumor biology. Recently, inflammation-based indexes, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), have been used to evaluate the prognosis of patients with diverse cancers. However, no data exists until now, evaluating the prognostic value of SII for ICC.

Research motivation

Timely and effective establishment of prognostic models for ICC patients undergoing curative resection is of great value for the long-term outcomes of these patients.

Research objectives

This study aimed to investigate the prognostic significance of SII in patients with ICC undergoing hepatic resection.

Research methods

We retrospectively reviewed ICC patients who underwent initial hepatectomy with curative intent at West China Hospital between January 2009 and September 2017. Enrolled patients were randomly stratified into derivation and validation cohort. The correlation between SII level and patients’ prognosis were analyzed using Kaplan-Meier curves and Cox proportional hazards regression.

Research results

Five hundred and thirty ICC patients were finally included and randomly divided into derivation (n = 265) and validation cohort (n = 265). The baseline characteristics were comparable between two groups. 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 correlated 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.

Research conclusions

Patients with increased SII level correlated 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.

Research perspectives

Future studies focusing on the molecular mechanisms underlying the correlation between SII level and patient clinical outcomes are required.