Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit

Abstract

ObjectivesTo investigate the prognostic significance of the systemic immune-inflammation index (SII) in patients after radical cholecystectomy for gallbladder cancer (GBC) using overall survival (OS) as the primary outcome measure.MethodsBased on data from a multi-institutional registry of patients with GBC, significant prognostic factors after radical cholecystectomy were identified by multivariate Cox proportional hazards model. A novel staging system was established, visualized as a nomogram. The response to adjuvant chemotherapy was compared between patients in different subgroups according to the novel staging system.ResultsOf the 1072 GBC patients enrolled, 691 was randomly selected in the discovery cohort and 381 in the validation cohort. SII>510 was found to be an independent predictor of OS (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.42-2.54). Carbohydrate antigen 199(CA19-9), tumor differentiation, T stage, N stage, margin status and SII were involved in the nomogram. The nomogram showed a superior prediction compared with models without SII (1-, 3-, 5-year integrated discrimination improvement (IDI):2.4%, 4.1%, 5.4%, P<0.001), and compared to TNM staging system (1-, 3-, 5-year integrated discrimination improvement (IDI):5.9%, 10.4%, 12.2%, P<0.001). The C-index of the nomogram in predicting OS was 0.735 (95% CI 0.683-0.766). The novel staging system based on the nomogram showed good discriminative ability for patients with T2 or T3 staging and with negative lymph nodes after R0 resection. Adjuvant chemotherapy offered significant survival benefits to these patients with poor prognosis.ConclusionsSII was an independent predictor of OS in patients after radical cholecystectomy for GBC. The new staging system identified subgroups of patients with T2 or T3 GBC with negative lymph nodes who benefited from adjuvant chemotherapy.Clinical Trial RegistrationClinicalTrials.gov, identifier (NCT04140552).

A Novel Clinically Prognostic Stratification Based on Prognostic Nutritional Index Status and Histological Grade in Patients With Gallbladder Cancer After Radical Surgery

“…Although various scoring systems are used in clinical practice, the preoperative prognostic models to predict the prognosis of patients with GBC remain controversial ( 9 – 11 ). These models were based on a number of hematological and clinical indicators, such as prognostic nutrition index (PNI), the diameter of tumor, jaundice, and TNM stage ( 12 – 15 ).…”

Prognostic role of the systemic immune-inflammation index in biliary tract cancers: a meta-analysis of 3,515 patients

“…The median sample size was 140 patients. Five studies included patients with ICC [ 18 , 24 , 26 , 27 , 31 ], three studies enrolled patients with ECC [ 17 , 32 , 33 ], three studies recruited patients with GBC [ 25 , 28 , 30 ], and two studies included patients with BTC [ 16 , 29 ]. All included studies reported the prognostic value of the SII for OS in BTC, five studies reported the association between the SII and RFS [ 24 , 26 , 27 , 31 , 33 ], and one study showed a correlation between the SII and PFS [ 29 ].…”

“…For example, Tsilimigras et al reported that an elevated SII was an independent prognostic marker for overall survival (OS) in patients with ICC (hazards ratio [HR], 1.70; 95% confidence interval [CI], 1.23–2.34; p =0.001) [ 26 ]. Moreover, Li et al also demonstrated that an SII of >510 was an independent predictor of OS (HR, 1.90; 95% CI, 1.42–2.54; p <0.001) in a multicenter study including 1072 patients with GBC [ 30 ]. However, some other studies reported that there was no significant difference between the SII and survival of patients with BTC.…”

“…Previous studies have shown that an elevated SII is associated with poor prognosis in non-small cell lung cancer (SCLC) [20], colorectal cancer [21], breast cancer [22], and renal cell carcinoma [23]. Many studies have also investigated the prognostic significance of the SII in BTC; however, the results were inconsistent [16][17][18][24][25][26][27][28][29][30][31][32][33]. Some studies identified the SII as a significant prognostic factor for BTC [27][28][29], whereas others reported that this association was nonsignificant [16,33].…”

Development of web-based dynamic nomogram to predict survival in patients with gastric cancer: a population-based study

“…Moreover, nomograms play a significant role in improving prognostic accuracy by combining all independent prognostic factors and quantifying their risks 22 , 23 . Nomogram, can be considered as a predictive statistical model for individual patients, reveals benefits than the conventional staging systems in predicting the outcomes of long-term survival in patients 24 . To the best of our knowledge, this study was the first survey on the predictive model regarding to nomogram presentation and OS for GC in Iran.…”