Prognostic Value of Systemic Immune-Inflammation Index-Based Nomogram in Patients with Extrahepatic Cholangiocarcinoma Treated by Percutaneous Transhepatic Biliary Stenting Combined with ¹²⁵I Seed Intracavitary Irradiation

Figures & data

Figure 1 Flow diagram of patients enrolled.

Table 1 Baseline Clinical Characteristics of the Participants

Variables	Total (n=145)	L-SII (n=69)	H-SII (n=76)	P-value
Gender				0.608
Male	91 (62.8)	45 (65.2)	46 (60.5)
Female	54 (37.2)	24 (34.8)	30 (39.5)
Age				0.247
<70	68 (46.9)	36 (52.2)	32 (42.1)
≥70	77 (53.1)	33 (47.8)	44 (57.9)
Tumor location				0.731
Hilar	92 (63.4)	45 (65.2)	47 (61.8)
Distal	53 (36.6)	24(34.8)	29 (38.2)
BMI (kg/m2)				1.000
<24	112 (77.2)	53 (76.8)	59 (77.6)
≥24	33 (22.8)	16 (23.2)	17 (22.4)
Postoperative chemotherapy				0.284
Yes	26 (17.9)	15 (21.7)	11 (14.5)
No	119 (82.1)	54 (78.3)	65 (85.5)
PAB (mg/l)				0.068
<0.2	77 (53.1)	31 (44.9)	46 (60.5)
≥0.2	68 (46.9)	38 (55.1)	30(39.5)
ALB (g/l)				<0.001
<33.5	93 (64.1)	34 (49.3)	59 (77.6)
≥33.5	52 (35.9)	35 (50.7)	17 (22.4)
ALP (U/l)				<0.001
<654	94 (64.9)	62 (89.8)	32 (44.9)
≥654	51 (35.2)	7 (10.2)	44(55.1)
GGT (U/l)				0.068
<250.5	70 (48.3)	39 (56.5)	31(40.8)
≥250.5	75 (51.7)	30 (43.5)	45 (59.2)
ALT (U/l)				0.619
<156.5	71 (49.0)	32 (46.4)	39 (51.3)
≥156.5	74 (51.0)	37 (53.6)	37 (48.7)
AST (U/l)				0.315
<151	81 (55.9)	42 (60.9)	39 (51.3)
≥151	64 (44.1)	27 (39.1)	37 (48.7)
CEA(ng/mL)				0.002
<4.7	69 (47.6)	48 (69.6)	33(43.4)
≥4.7	76 (52.4)	21 (30.4)	43 (56.6)
TBIL(μmol/l)				<0.001
<213.5	49 (33.8)	35 (50.7)	14 (18.4)
≥213.5	96 (66.2)	34 (49.3)	62 (81.6)
PT (s)				0.868
<12.4	71 (49.0)	33 (47.8)	38 (50.0)
≥12.4	74 (51.0)	36 (52.2)	38(50.0)
CA19-9 (U/mL)				<0.001
<695	59(40.7)	46 (66.7)	13 (17.1)
≥695	86 (59.3)	23 (33.3)	63 (82.9)
hsCRP (mg/l)				0.615
<11.9	82 (56.6)	41 (59.4)	41 (53.9)
≥11.9	63 (43.4)	28 (40.6)	35 (46.1)

Abbreviations: SII, Systemic Immune-Inflammation Index; BMI, Body Mass Index; PAB, prealbumin; ALB, albumin; ALP, a lkaline phosphatase; GGT, gamma-glutamyl transpeptidase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CEA, carcinoembryonic antigen; TBIL, total bilirubin; PT, prothrombin time; CA19-9, Carbohydrate antigen 199; hsCRP, high-sensitivity C-reactive protein.

Table 2 Correlation Between SII and Clinical Variables in EHCC Patients

Variables	SII
	r	P
ALB	−0.295	<0.001
ALP	0.499	<0.001
CEA	0.263	0.001
TBIL	0.341	<0.001
CA19-9	0.504	<0.001

Abbreviations: ALB, albumin; ALP, a lkaline phosphatase; CEA, carcinoembryonic antigen; TBIL, total bilirubin; CA19-9, Carbohydrate antigen 199.

Figure 2 Continued.

Figure 2 Kaplan–Meier curves indicating OS of EHCC patients after PTBS combined with 125I seed implantation. The whole cohort (A); stratified by the value of SII in the whole cohort (B), stratified according to the SII level in the hCCA subgroup (C), and stratified according to the SII level in the dCCA subgroup (D).

Table 3 Univariate Analyses of Features Correlated with OS of EHCC Patients

Variables	HR	95% CI	P
Gender (M/F)	1.135	0.780–1.653	0.507
Age (<70 vs ≥70 years)	1.326	0.917–1.918	0.133
Tumor location (perihilar/distal)	0.840	0.572–1.235	0.376
BMI (<24 vs ≥24kg/m^2)	1.904	1.256–2.885	0.002
Postoperative chemotherapy (Yes/No)	4.912	2.695–8.952	<0.001
PAB (<0.2 vs ≥0.2mg/l)	0.802	0.556–1.156	0.237
ALB (<35 vs ≥35) g/l)	0.722	0.487–1.072	0.106
ALP (<654 vs ≥654U/l)	1.441	0.992–2.094	0.055
GGT (<250.5 vs ≥250.5U/l)	0.833	0.578–1.199	0.325
ALT (<156.5 vs ≥156.5U/l)	0.580	0.400–0.842	0.004
AST (<151 vs ≥151U/l)	0.914	0.633–1.317	0.628
CEA (<5.2 vs ≥5.2ng/mL)	1.102	0.764–1.587	0.604
TBIL (<213.5 vs ≥213.5μmol/l)	2.537	1.644–3.913	<0.001
PT (<12.4 vs ≥12.4s)	1.269	0.878–1.834	0.205
CA19-9 (<695 vs ≥695U/mL)	2.772	1.841–4.173	<0.001
hsCRP (<11.9 vs ≥11.9mg/l)	1.180	0.819–1.702	0.374
SII (low/high)	2.423	1.650–3.557	<0.001

Abbreviations: BMI, Body Mass Index; PAB, prealbumin; ALB, albumin; ALP, a lkaline phosphatase; GGT, gamma-glutamyl transpeptidase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CEA, carcinoembryonic antigen; TBIL, total bilirubin; PT, prothrombin time; CA19-9, Carbohydrate antigen 199; hsCRP, high-sensitivity C-reactive protein; SII, Systemic Immune-Inflammation Index.

Figure 3 Forest plot based on the results of multivariate analysis of the indicators associated with OS.

Figure 4 Survival nomogram based on SII.The total points of every patient can be used to predict the OS of EHCC patients.

Figure 5 Continued.

Figure 5 Calibration curves for 1-year (A), 2-year (B) OS for the nomogram with internal validation. (C) Time-dependent ROC of the nomogram for predicting OS. (D) Decision curve analysis of the nomogram.