The Prognostic Value of Systemic Inflammation Response Index in Cholangiocarcinoma Patients

Abstract

Purpose

We determined the prognostic value of the systemic inflammation response index (SIRI) in patients with cholangiocarcinoma after surgery and constructed a survival prediction model based on SIRI.

Patients and Methods

We recruited 328 patients with histopathologically confirmed cholangiocarcinoma from 2003 to 2017 and performed Kaplan–Meier survival and Cox analyses to analyze the prognostic value of the SIRI and identify other significant factors. A nomogram involving SIRI and other clinicopathological factors was established based on the training cohort. The concordance index (C-index), decision curve analysis, calibration plots, and Hosmer–Lemeshow test were used to evaluate the clinical utility of the nomogram and to compare it with the traditional TNM staging system. The results were validated using a separate validation cohort.

Results

The patients were randomly divided into the training (n = 232) and validation (n = 96) cohorts. In the training cohort, the independent factors derived from the Cox multivariate analysis were SIRI, platelet-to-lymphocyte ratio, jaundice, γ-glutamyl transpeptidase level, maximal tumor size, N stage, M stage, and radical surgery. Time-dependent receiver operating characteristic (ROC) curves showed higher AUC for SIRI than those for other inflammation-based biomarkers. A nomogram containing all the independent factors showed good discrimination and calibration. The C-index values for overall survival, 0.737 (95% Cl: 0.683–0.791) and 0.738 (95% Cl: 0.679–0.797) in the training and validation cohorts, respectively, were significantly better than those for the TNM staging system [0.576 (95% Cl: 0.515–0.637) and 0.523 (95% Cl: 0.465–0.581), respectively].

Conclusion

SIRI was an independent prognostic factor for cholangiocarcinoma. A prognostic model based on SIRI might help clinicians to stratify patients more precisely and provide individualized treatment.

Keywords:

• systemic inflammation response index
• cholangiocarcinoma
• prognosis
• nomogram
• survival

Acknowledgments

The authors would like to thank Dr. H. Nikki March and Dr. Vikas Narang from Editage, for editing the English text of a draft of this manuscript.

Abbreviations

SIRI, systemic inflammation response index; ROC, receiver operating characteristic; TMN, tumor node metastasis; AJCC, American Joint Committee on Cancer; MLR, monocyte-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; PUMCH, Peking Union Medical College Hospital; OS, overall survival; CA 19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; C-index, Harrell’s concordance index; DCA, decision curve analysis; LDH, lactate dehydrogenase; ECC, extrahepatic cholangiocarcinoma; ICC, intrahepatic cholangiocarcinoma; GGT, glutamyl transpeptidase (GGT); ALP, alkaline phosphatase; Alb, albumin; HR, hazard ratio; CI, confidence interval; AUC, area under the receiver operating characteristic curve; TNF-α, tumor necrosis factor-alpha; IFN-γ, interferon-gamma.

Ethics Approval and Informed Consent

This study was conducted in accordance with the ethical standards of the Declaration of Helsinki and has been approved by the Institutional Review Board of Peking Union Medical College Hospital (Number: S-K1110). Written informed consent was obtained from all patients.

Disclosure

The authors have no conflicts of interest to declare.