Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.467
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
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.
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.
This study aimed to investigate the prognostic significance of SII in patients with ICC undergoing hepatic resection.
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.
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.
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.
Future studies focusing on the molecular mechanisms underlying the correlation between SII level and patient clinical outcomes are required.