The Impacts of Systemic Immune-Inflammation Index on Clinical Outcomes in Gallbladder Carcinoma
Lejia Sun, Yukai Jin, Wenmo Hu, Mengyuan Zhang, Bao Jin, Haifeng Xu, Shunda Du, Yiyao Xu, Haitao Zhao, Xin Lü, Xinting Sang, Shouxian Zhong, Huayu Yang, Yilei Mao
Abstract
Systemic immune-inflammation index (SII) is considered to be a prognostic marker in several cancers. However, the prognostic value of baseline pre-operative SII in gallbladder carcinoma (GBC) has not been evaluated. This study aimed to determine the prognostic significance of SII and generate a predictive nomogram. We retrospectively studied 142 GBC patients who underwent surgical resection at the Peking Union Medical College Hospital between 2003 and 2017. SII, neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were evaluated for their prognostic values. A multivariate Cox proportional hazards model was used to construct a nomogram. Calibration curves were used to estimate the performance of the nomogram and decision curve analysis was performed to evaluate its net benefit. The predictive accuracy of SII (Harrell’s concordance index [C-index]: 0.624), NLR (C-index: 0.626) and LMR (C-index: 0.622) was evaluated. The multivariate Cox model showed that SII was a superior independent predictor than NLR and LMR were. SII level (≥600) (hazard ratio [HR]: 1.555; 95% confidence interval [CI]: 1.007–2.401; P=0.047), CA19-9 level (≥37 U/ml) (HR: 2.375; 95% CI: 1.487–3.792; P<0.001) and TNM stage (P=0.026) were selected to construct a nomogram for predicting overall survival (OS). The predictive ability of this model was assessed by C-index (0.752). Good performance was demonstrated by the calibration plot. A high net benefit was proven by DCA. SII is an independent prognostic indicator in GBC patients after surgical resection, and the nomogram based on it is a useful tool for predicting OS.