Preoperative systemic inflammatory response index as a prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy

Table 1 The clinical characteristics of primary cohort

Variables	Total (n = 216)	Low SIRI (n = 123)	High SIRI (n = 93)	P value
Patient basic factors
Age (year)
≥ 70	79	35	44	0.004a
< 70	137	88	49
Gender
Male	126	67	59	0.186
Female	90	56	34
Main symptom
Abdominal pain	23	16	7	0.213
Jaundice	182	99	83
Other	11	8	3
Smoking
Yes	64	31	33	0.101
No	152	92	60
Diabetes
Yes	58	31	27	0.530
No	158	92	66
Epigastrium surgery
Yes	20	13	7	0.445
No	196	110	86
Cardiocerebrovascular disease
Yes	109	50	59	0.001a
No	107	73	34
Preoperative biliary drainage
ERCP	24	18	6	< 0.001a
PTBD	81	36	45
No	111	69	42
Laboratory parameters
Platelet (109/L)
≥ 311	43	18	25	0.026a
< 311	173	105	68
WBC (109/L)
≥ 7.2	65	16	49	< 0.001a
< 7.2	151	107	44
Neutrophil (109/L)
≥ 3.6	137	51	86	< 0.001a
< 3.6	79	72	7
Monocyte (109/L)
≥ 0.5	78	17	61	< 0.001a
< 0.5	138	106	32
Lymphocyte (109/L)
≥ 1.8	49	42	7	< 0.001a
< 1.8	167	81	86
ALT (U/L)
≥ 190.5	35	23	12	0.252
< 190.5	181	100	81
AST (U/L)
≥ 16.5	206	118	88	0.650
< 16.5	10	5	5
Hemoglobin (g/L)
≥ 112	132	83	49	0.027a
< 112	84	40	44
Albumin (g/dL)
≥ 35.7	100	66	34	0.013a
< 35.7	116	57	59
TB (μmol/L)
≥ 144.4	83	40	43	0.040a
< 144.4	133	83	50
DB (μmol/L)
≥ 113.8	84	42	42	0.100
< 113.8	132	81	51
-GGT (U/L)
≥ 646.5	66	39	27	0.673
< 646.5	150	84	66
CEA (ng/mL)
≥ 0.2	209	117	92	0.118
< 0.2	7	6	1
CA19-9 (U/mL)
≥ 235.8	61	24	37	0.001a
< 235.8	155	99	56
PLR
≥ 143	145	65	80	< 0.001a
< 143	71	58	13
NLR
≥ 3.1	112	32	80	< 0.001a
< 3.1	104	91	13
LMR
≥ 3.2	100	92	8	< 0.001a
< 3.2	116	31	85
NMR
≥ 11.2	69	37	32	0.499
< 11.2	147	86	61
ABR
≥ 0.3	120	76	44	0.034a
< 0.3	96	47	49
SII
≥ 682	123	39	84	< 0.001a
< 682	93	84	9
ICPI
≥ 445.4	133	57	76	< 0.001a
< 445.4	83	66	17
APRI
≥ 0.3	178	103	75	0.554
< 0.3	38	20	18
Operative outcomes
Operative duration (hours)	10.1 ± 2.6	10.1 ± 2.6	10.1 ± 2.6	0.900
Total blood loss (mL)	618.8 ± 517.5	621.3 ± 535.6	616.8 ± 505.2	0.950
Blood transfusion (mL)	308.3 ± 538.8	259.6 ± 511.0	345.9 ± 558.7	0.244
Postoperative outcomes
Ventilator use duration (hours)	20.9 ± 27.5	18.4 ± 20.9	22.9 ± 31.6	0.234
ICU duration (days)	3.5 ± 3.3	3.4 ± 3.2	3.7 ± 3.6	0.347
Postoperative time (days)	27.0 ± 18.2	26.0 ± 15.8	27.7 ± 19.9	0.498

^aP < 0.05.

PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil to lymphocyte ratio; LMR: Lymphocyte to monocyte ratio; NMR: Neutrophil-to-monocyte ratio; APRI: Aspartate transaminase-to-platelet; ABR: Albumin to bilirubin ratio; ICPI: Inflammation-combined prognostic index; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index; ERCP: Endoscopic retrograde cholangio pancreatography; PTBD: Percutaneous transhepatic biliary drainage; WBC: White blood count; ALT: Alanine aminotransferase; AST: Aspartate transaminase; TB: Total bilirubin; DB: Direct bilirubin; -GGT: -glutamyl transpeptidase; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; ICU: Intensive care unit.

Table 2 Pathological characteristics of the patients classified by the systemic inflammatory response index

Variables	Total (n = 216)	Low SIRI (n = 123)	High SIRI (n = 93)	P value
pT stage
Tis	3	2	1	0.654
T1, T2	26	17	9
T3, T4	184	103	81
Unknown	3	1	2
pN stage
N0	111	67	44	0.676
N1	74	41	33
N2	29	14	15
Unknown	2	1	1
pM stage
M0	204	118	86	0.271
M1	12	5	7
Tumor differentiation
Well	25	19	6	0.097
Moderate	90	54	36
Poor	26	13	13
Other	75	37	38
Tumor size (cm)
≥ 1.8	140	74	66	0.045a
< 1.8	74	49	25
Unknown	2	0	2
Microscopic lymphatic invasion
Yes	103	55	48	0.578
No	111	67	44
Unknown	2	1	1
Microscopic venous invasion
Yes	36	17	19	0.214
No	179	106	73
Unknown	1	0	1
Microscopic arterial invasion
Yes	6	2	4	0.344
No	207	120	87
Unknown	3	1	2
Peripheral organ invasion
Yes	3	2	1	0.670
No	210	120	90
Unknown	3	1	2
Venous invasion type
1-2	24	15	9
3-4	12	2	10	0.014a
No	180	106	74
Perineural invasion
Yes	189	104	85	0.268
No	25	18	7
Unknown	2	1	1
Distant metastasis
Yes	12	5	7	0.189
No	204	118	76
Incisal edge
Positive	24	14	10	0.884
Negative	192	109	83
Residual tumor status
R0	191	109	82	0.490
R1	19	10	9
R2	6	2	4

^aP < 0.05.

SIRI: Systemic inflammatory response index.

Table 3 Cox regression analysis of the effects of clinicopathological factors on the overall survival of patients

Variables	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age (year)	1.022 (1.003-1.042)	0.025a	1.008 (0.987-1.029)	0.471
Cardiocerebrovascular disease	1.424 (1.020-1.986)	0.038a	1.428 (0.989-2.063)	0.058
Preoperative biliary drainage	1.166 (0.974-1.396)	0.094	0.746 (0.401-1.389)	0.355
Platelet (109/L)	1.002 (1.000-1.004)	0.101	1.001 (0.996-1.007)	0.661
WBC (109/L)	1.044 (0.975-1.118)	0.219
Neutrophil (109/L)	1.089 (1.011-1.174)	0.025a	1.110 (0.900-1.369)	0.330
Monocyte (109/L)	2.000 (1.048-3.818)	0.036a	0.078 (0.003-1.761)	0.109
Lymphocyte (109/L)	0.624 (0.469-0.830)	0.001a	0.598 (0.287-1.245)	0.169
Hemoglobin (g/L)	0.990 (0.981-0.999)	0.022a	1.001 (0.989-1.013)	0.895
Albumin (g/dL)	1.560 (1.104-2.204)	0.012a	0.983 (0.948-1.019)	0.345
TB (μmol/L)	1.002 (1.001-1.004)	0.003a	1.002 (1.000-1.004)	0.030a
CA19-9 (U/mL) (> 235.8)	1.000 (1.000-1.000)	0.000a	1.000 (0.999-1.000)	0.000a
PLR (> 143)	1.003 (1.002-1.005)	0.000a	1.000 (0.995-1.005)	0.898
NLR (> 3.1)	1.093 (1.042-1.146)	0.000a	0.702 (0.525-0.939)	0.017
LMR (> 3.2)	0.807 (0.726-0.898)	0.000a	0.934 (0.712-1.225)	0.621
NMR (> 11.2)	0.992 (0.969-1.015)	0.490
ABR (> 0.3)	0.937 (1.091-2.054)	0.403
SII (> 682)	1.000 (1.000-1.001)	0.000a	1.000 (0.999-1.001)	0.644
SIRI (> 1.5)	1.167 (1.092-1.247)	0.000a	1.868 (1.194-2.920)	0.006a
ICPI (> 445.4)	1.001 (1.001-1.002)	0.000a	3.108 (1.710-5.651)	0.305
APRI (> 0.3)	1.016 (0.877-1.177)	0.831
Tumor size (cm) (> 1.8)	1.292 (1.116-1.497)	0.001a	1.343 (1.130-1.596)	0.001a
Venous invasion type	1.371 (0.430-4.368)	0.594

^aP < 0.05.

PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil to lymphocyte ratio; LMR: Lymphocyte to monocyte ratio; NMR: Neutrophil-to-monocyte ratio; APRI: Aspartate transaminase-to-platelet; ABR: Albumin to bilirubin ratio; ICPI: Inflammation-combined prognostic index; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index; HR: Hazard ratio; CI: Confidence interval; WBC: White blood count; TB: Total bilirubin; CA19-9: Carbohydrate antigen 19-9.

Table 4 Cox regression analysis of the effects of clinicopathological factors on the recurrence-free survival of patients

Variables	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age (year)	1.001 (0.980-1.023)	0.931
Cardiocerebrovascular disease	1.225 (0.844-1.777)	0.285
Preoperative biliary drainage	0.679 (0.343-1.342)	0.265
Platelet (109/L)	1.002 (0.999-1.005)	0.229
WBC (109/L)	0.978 (0.906-1.056)	0.565
Neutrophil (109/L)	0.999 (0.914-1.091)	0.982
Monocyte (109/L)	0.839 (0.409-1.720)	0.632
Lymphocyte (109/L)	0.695 (0.516-0.936)	0.017a	0.834 (0.478-1.456)	0.523
Hemoglobin (g/L)	1.001 (0.991-1.011)	0.872
Albumin (g/dL)	1.019 (0.989-1.051)	0.221
TB (μmol/L)	1.001 (0.999-1.002)	0.469
CA19-9 (U/mL) (> 69.3)	1.000 (1.000-1.000)	0.970
PLR (> 159.8)	1.003 (1.001-1.005)	0.001a	1.000 (0.995-1.004)	0.811
NLR (> 2.8)	1.129 (1.024-1.245)	0.015a	0.895 (0.694-1.155)	0.393
LMR (> 1.1)	0.888 (0.798-0.989)	0.030a	0.922 (0.771-1.101)	0.368
NMR (> 11.5)	0.992 (0.959-1.026)	0.624
ABR (> 3.7)	0.938 (0.792-1.112)	0.463
SII (> 496.6)	1.001 (1.000-1.001)	0.002a	1.001 (1.000-1.002)	0.146
ICPI (> 445.4)	1.001 (1.000-1.002)	0.001a	0.894 (0.784-1.020)	0.096
APRI (> 1.7)	1.032 (0.866-1.229)	0.726
SIRI (> 1.1)	1.080 (0.972-1.200)	0.001a	0.949 (0.752-1.199)	0.000a
Tumor size (cm) (> 1.8)	1.258 (1.013-1.561)	0.038a	1.144 (0.887-1.475)	0.229
Venous invasion type	1.503 (0.819-2.759)	0.189	1.577 (0.566-4.391)	0.383

^aP < 0.05.

PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil to lymphocyte ratio; LMR: Lymphocyte to monocyte ratio; NMR: Neutrophil-to-monocyte ratio; APRI: Aspartate transaminase-to-platelet; ABR: Albumin to bilirubin ratio; ICPI: Inflammation-combined prognostic index; SII: Systemic immune-inflammation index; SIRI: Systemic inflammatory response index; HR: Hazard ratio; CI: Confidence interval; WBC: White blood count; TB: Total bilirubin; CA19-9: Carbohydrate antigen 19-9.