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Prognostic Utility of Systemic Immune-Inflammation Index After Resection of Extrahepatic Cholangiocarcinoma: Results from the U.S. Extrahepatic Biliary Malignancy Consortium

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to define the association of the systemic immune inflammation index (SII) with prognosis and adjuvant therapy benefit among patients undergoing resection of extrahepatic cholangiocarcinoma (eCCA).

Methods

The impact of SII on overall (OS) and recurrence-free survival (RFS) following resection of eCCA was assessed and compared with other inflammatory markers and traditional prognostic factors. Propensity score matching (PSM) was used to determine the impact of adjuvant therapy (AT) on OS and RFS relative to low versus high SII.

Results

Patients with high versus low SII had worse 5-year OS (15.9% vs. 27.9%) and RFS (12.4% vs. 20.9%) (both p < 0.01). On multivariate analysis, high SII remained associated with worse OS (HR = 1.50, 95% CI 1.20-1.87) and RFS (HR = 1.46, 95% CI 1.18-1.81). Patients with T1/2 disease and a high-SII had worse 5-year OS versus individuals with T3/4 disease and low-SII (5-year OS: T1/2 & low-SII 35.6%, T1/2 & high-SII 16.4%, T3/4 & low-SII 22.1%, T3/4 & high-SII 15.6%, p < 0.01). Similarly, 5-year OS was comparable among individuals with N0 and high-SII versus N1 and low-SII (5-year OS: N0 & high-SII 23.2%, N1 and low-SII 19.8%, p = 0.95). On PSM, AT improved OS and RFS among patients with high SII (5-year OS: 22.5% vs. 12.3%, p < 0.01, 5-year RFS: 19.0% vs. 12.5%; p = 0.01) but not individuals with low SII (5-year OS: 22.9% vs. 26.9%; p = 0.98, 5-year RFS: 18.5% vs. 19.9%; p = 0.94).

Conclusions

SII was independently associated with postoperative OS and RFS following curative-intent resection of eCCA. High SII up-staged patients relative T- and N-categories and identified patients with high SII as the most likely to benefit from AT.

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Author notes

  1. Dr. Toyoda and Dr. Sahara have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Junya Toyoda MD, Kota Sahara MD & Itaru Endo MD, PhD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA

    Kota Sahara MD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  4. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott MD

  5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD

  6. Department of Surgery, New York University, New York, NY, USA

    Christopher Wolfgang MD

  7. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD

  8. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Jin He MD

  9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Charles Scoggins MD

  10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Kamran Idrees MD

  11. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD

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Toyoda, J., Sahara, K., Maithel, S.K. et al. Prognostic Utility of Systemic Immune-Inflammation Index After Resection of Extrahepatic Cholangiocarcinoma: Results from the U.S. Extrahepatic Biliary Malignancy Consortium. Ann Surg Oncol 29, 7605–7614 (2022). https://doi.org/10.1245/s10434-022-12058-2

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