High Systemic Inflammation Response Index (SIRI) Indicates Poor Outcome in Gallbladder Cancer Patients with Surgical Resection: A Single Institution Experience in China

Lejia Sun, Wenmo Hu, Meixi Liu, Yang Chen, Bao Jin, Haifeng Xu, Shunda Du, Yiyao Xu, Haitao Zhao, Xin Lu, Xinting Sang, Shouxian Zhong, Huayu Yang, Yilei Mao, Lejia Sun, Wenmo Hu, Meixi Liu, Yang Chen, Bao Jin, Haifeng Xu, Shunda Du, Yiyao Xu, Haitao Zhao, Xin Lu, Xinting Sang, Shouxian Zhong, Huayu Yang, Yilei Mao

Abstract

Purpose: The systemic inflammation response index (SIRI) has been reported to have prognostic ability in various solid tumors but has not been studied in gallbladder cancer (GBC). We aimed to determine its prognostic value in GBC.

Materials and methods: From 2003 to 2017, patients with confirmed GBC were recruited. To determine the SIRI's optimal cutoff value, a time-dependent receiver operating characteristic curve was applied. Univariate and multivariate Cox analyses were performed for the recognition of significant factors. Then the cohort was randomly divided into the training and the validation set. A nomogram was constructed using the SIRI and other selected indicators in the training set, and compared with the TNM staging system. C-index, calibration plots, and decision curve analysis were performed to assess the nomogram's clinical utility.

Results: One hundred twenty-four patients were included. The SIRI's optimal cutoff value divided patients into high (≥ 0.89) and low SIRI (< 0.89) groups. Kaplan-Meier curves according to SIRI levels were significantly different (p < 0.001). The high SIRI group tended to stay longer in hospital and lost more blood during surgery. SIRI, body mass index, weight loss, carbohydrate antigen 19-9, radical surgery, and TNM stage were combined to generate a nomogram (C-index, 0.821 in the training cohort, 0.828 in the validation cohort) that was significantly superior to the TNM staging system both in the training (C-index, 0.655) and validation cohort (C-index, 0.649).

Conclusion: The SIRI is an independent predictor of prognosis in GBC. A nomogram based on the SIRI may help physicians to precisely stratify patients and implement individualized treatment.

Keywords: Gallbladder neoplasms; Nomogram; Overall survival; Prognosis; Systemic inflammation response index (SIRI).

Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Time-dependent receiver operating characteristic (ROC) analysis of systemic inflammation response index (SIRI) for 1-, 3-, and 5-year survival. AUC, area under the curve.
Fig. 2.
Fig. 2.
Kaplan-Meier survival curves of different systemic inflammation response index (SIRI) groups.
Fig. 3.
Fig. 3.
Time-dependent receiver operating characteristic analysis of each of the selected factors and the prognostic model. SIRI, systemic inflammation response index; BMI, body mass index; CA19-9, carbohydrate antigen 19-9; AUC, area under the curve.
Fig. 4.
Fig. 4.
Prognostic nomogram for predicting 1-, 3-, and 5-year overall survival probability based on the systemic inflammation response index (SIRI) group, body mass index (BMI), weight loss, carbohydrate antigen 19-9 (CA19-9), radical surgery, and TNM stage in patients with gallbladder cancer.
Fig. 5.
Fig. 5.
Nomogram calibration plot for predicting overall survival probabilities at 1 year (A, C) and 3 years (B, D).
Fig. 6.
Fig. 6.
Decision curve analysis (DCA) of the model and TNM staging system for 1- (A, B), 3- (C, D), and 5-year (E, F) overall survival (OS).
Fig. 7.
Fig. 7.
Histograms of nomogram-predicted probability of 12-month survival according to the different American Joint Committee on Cancer TNM stage groupings.

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Source: PubMed

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