Prognostic and recurrent significance of SII in patients with pancreatic head cancer undergoing pancreaticoduodenectomy

Qing Chen, Siqian Ren, Songping Cui, Jincan Huang, Di Wang, Binglin Li, Qiang He, Ren Lang, Qing Chen, Siqian Ren, Songping Cui, Jincan Huang, Di Wang, Binglin Li, Qiang He, Ren Lang

Abstract

Background: To investigate the clinical significance of preoperative inflammatory status in patients with pancreatic head carcinoma (PHC), we performed a single-center study to assess it.

Method: We studied a total of 164 patients with PHC undergoing PD surgery (with or without allogeneic venous replacement) from January 2018 to April 2022. Systemic immune-inflammation index (SII) was the most important peripheral immune index in predicting the prognosis according to XGBoost analysis. The optimal cutoff value of SII for OS was calculated according to Youden index based on the receiver operating characteristic (ROC) curve and the cohort was divided into Low SII group and High SII group. Demographic, clinical data, laboratory data, follow-up data variables were obtained and compared between the two groups. Kaplan-Meier curves, univariable and multivariable Cox regression models were used to determine the association between preoperative inflammation index, nutritional index and TNM staging system with OS and DFS respectively.

Results: The median follow-up time was 16 months (IQR 23), and 41.4% of recurrences occurred within 1 year. The cutoff value of SII was 563, with a sensitivity of 70.3%, and a specificity of 60.7%. Peripheral immune status was different between the two groups. Patients in High SII group had higher PAR, NLR than those in Low SII group (P <0.01, <0.01, respectively), and lower PNI (P <0.01). Kaplan-Meier analysis showed significantly poorer OS and DFS (P < 0.001, <0.001, respectively) in patients with high SII. By using the multivariable Cox regression model, high SII (HR, 2.056; 95% CI, 1.082-3.905, P=0.028) was significant predictor of OS. Of these 68 high-risk patients who recurrence within one year, patients with widespread metastasis had lower SII and worse prognosis (P <0.01).

Conclusion: High SII was significantly associated with poor prognosis in patients with PHC. However, in patients who recurrence within one year, SII was lower in patients at TNM stage III. Thus, care needs to be taken to differentiate those high-risk patients.

Keywords: pancreatic head carcinoma; prononsis; recurrence; surgery; systemic immune-inflammation index.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Chen, Ren, Cui, Huang, Wang, Li, He and Lang.

Figures

Figure 1
Figure 1
Flow chart of patient’s enrollment in the study.
Figure 2
Figure 2
The feature importance associated with survival analyze by eXtreme Gradient Boosting (XGBoost) classifier.
Figure 3
Figure 3
(A) Kaplan-Meier curves for OS according to SII level. OS of patients with SII≦563 was significantly longer than that of patients with SII>563 (P=0.001 by log-rank test). OS, overall survival. (B) Kaplan-Meier curves for 1-year OS according to SII level (P<0.001 by log-rank test). OS, overall survival.
Figure 4
Figure 4
(A) Kaplan-Meier curves for DFS according to SII level. DFS of patients with SII≦563 was significantly longer than that of patients with SII>563 (P=0.001 by log-rank test). DFS, disease-free survival. (B) Kaplan-Meier curves for 1-year DFS according to SII level (P<0.001 by log-rank test). DFS, disease-free survival.
Figure 5
Figure 5
(A) Histogram of SII according to site of recurrence in patients who relapsed within one year. (B) Kaplan-Meier curves for OS according to site of recurrence in patients who relapsed within one year. *P<0.05, **P<0.01, "ns" represents no difference.

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