Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Ann Surg. 2019 Jul;270(1):139-146. doi: 10.1097/SLA.0000000000002660.
Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome.
Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index.
We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated.
In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55-3.48], lymph node ratio (HR 3.75, 95% CI 2.08-6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07-2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L.
SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.
本研究旨在以癌症特异性生存为主要终点，确定系统免疫炎症指数（SIII）在可切除胰腺癌患者中的预后意义。
胰腺癌与免疫系统功能障碍和不良预后相关。我们检测了 SIII 在可切除胰腺导管腺癌（PDAC）患者中的预后意义，以及胆红素对该指数的影响。
我们回顾性评估了 2004 年至 2015 年在 4 个三级转诊中心进行的所有胰腺切除术，以确定经病理证实的 PDAC 患者。收集了基线临床病理特征、术前实验室值，如绝对中性粒细胞、淋巴细胞和血小板计数、C 反应蛋白、白蛋白、胆红素和 CA19-9 水平，以及随访信息。计算出的炎症指数与结局的关联在内部和外部均进行了验证。
共纳入 590 例可切除 PDAC 患者。发现队列和验证队列分别纳入 170 例和 420 例患者。SIII＞900[风险比（HR）2.32，95%置信区间（CI）1.55-3.48]、淋巴结比率（HR 3.75，95% CI 2.08-6.76）和 CA19.9＞200kU/L（HR 1.62，95% CI 1.07-2.46）被确定为癌症特异性生存的独立预测因素。单独的模型分析证实，术前 SIII 对预后有显著贡献。然而，在胆红素水平＞200μmol/L 的患者中，SIII 似乎失去了其预后意义。
SIII 是可切除 PDAC 患者癌症特异性生存和复发的独立预测因素。在胆红素水平较高的患者中，SIII 可能失去其预后意义。需要进行适当的前瞻性研究来进一步证实这一假设。
