The prognostic effect of the systemic immune-inflammation index on overall survival of periampullary cancer

Abstract

Objective

The systemic immune-inflammation index (SII) is used to assess survival in many cancers. SII has been examined separately in pancreatic head, ampulla, and distal choledochus cancers, and different cut-off values were found. Detecting the location of periampullary cancer before surgery may be difficult or misleading. This study aimed to investigate the use of SII in predicting overall survival (OS) with periampullary cancers regardless of tumor location.

Methods

Between January 2010 and January 2020, 163 patients who underwent pancreaticoduodenectomy for periampullary tumors were assessed. After applying the exclusion criteria, data from 116 patients with cancer who underwent pancreaticoduodenectomy were included in the study.

Results

OS was compared using Kaplan-Meier curves. The prognostic significance of baseline SII and other factors were assessed in univariate and multivariate analyses using the Cox proportional hazard regression model. Univariate analysis demonstrated that age ≥60.5 years (hazard ratio [HR]: 2.042, 95% CI: [1.355–3.078]; p = 0.001), male sex (HR: 1.863, 95% CI: [1.231–2.821]; p = 0.003), tumor in the pancreatic head vs. ampulla (HR: 2.150, 95% CI: [1.364–3.389]; p = 0.001), tumor in the pancreatic head vs. distal choledochus (HR: 1.945, 95% CI: [1.091–3.472]; p = 0.024), N (+) stage (HR: 1.868, 95% CI: [1.223–2.854]; p = 0.004), total bilirubin level >0.35 (HR: 2.131, 95% CI: [1.245–3.649]; p = 0.006), NLR >2.13 (HR: 1.911, 95% CI: [1.248–2.925]; p = 0.003), and SII >704 (HR: 1.966, 95% CI: [1.310–2.950]; p = 0.001) were significantly associated with OS. Multivariate analysis revealed that SII >704 (HR: 2.375; p < 0.001), age ≥ 60.5 years (HR: 2.728; p < 0.001), N-stage positivity (HR: 3.431; p < 0.001), and tumor in the pancreatic head vs. ampulla (HR: 2.801; p < 0.001) were independently associated with poor survival. There was no difference between tumor locations in terms of SII (p = 0.206).

Conclusions

SII is an independent prognostic risk factor and may be a marker for predicting OS in patients with periampullary cancer. There was no statistical difference between the tumor locations in terms of SII. A single cut-off value of SII may be used for periampullary cancer survival without the need for a pathology specimen.

Keywords:

• Periampullary cancer
• pancreas
• distal choledochus
• ampulla
• systemic immune-inflammation index
• neutrophil-to-lymphocyte ratio

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Mesut Yur and Şafak Özer Balin designed the research. Mesut Yur and Erhan Aygen performed the study and analyzed data. Mesut Yur, Şafak Özer Balin, and Serkan Yılmaz extracted the data and wrote the main manuscript text. Mesut Yur, Yavuz Selim İlhan, and Mehmet Fatih Ebiloğlu edited and revised the manuscript. All authors reviewed and approved the manuscript.

Acknowledgements

None.

Data availability statement

The data that support the findings of this study are available from the corresponding author under request.

Ethics statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.