Kawashima Jun, Akabane Miho, Khalil Mujtaba, Woldesenbet Selamawit, Chatzipanagiotou Odysseas P, Endo Yutaka, Sahara Kota, Cauchy François, Aucejo Federico, Marques Hugo P, Lopes Rita, Rodriguea Andreia, Hugh Tom, Shen Feng, Maithel Shishir K, Koerkamp Bas Groot, Popescu Irinel, Kitago Minoru, Weiss Matthew J, Martel Guillaume, Pulitano Carlo, Aldrighetti Luca, Poultsides George, Ruzzente Andrea, Bauer Todd W, Gleisner Ana, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
Ann Surg Oncol. 2025 Jul 9. doi: 10.1245/s10434-025-17781-0.
Accurate preoperative diagnosis of nodal status in intrahepatic cholangiocarcinoma (ICC) remains challenging. The objective of the current study was to determine if the systemic immune-inflammatory index (SII) was associated with occult nodal disease (OND) among cN0 patients undergoing resection for ICC.
Patients who underwent curative resection for ICC were identified from an international multi-institutional database. A multivariable logistic regression model was used to assess the relationship between SII and OND.
Among 490 patients who underwent curative resection with lymph node dissection (LND) for cN0 ICC, 135 (27.6%) had OND. Among these individuals, high SII (≥738.4) was independently associated with OND (odds ratio [OR], 1.85, 95% confidence interval [CI], 1.18-2.92). This association was consistent even among patients with cT1aN0M0 disease (OR, 1.85; 95% CI, 1.19-2.88). Interestingly, among patients with high SII and N0/Nx disease, individuals whose total number of lymph nodes examined (TLNE) was fewer than six had worse 3-year recurrence-free survival (RFS) than patients with a TLNE of six or more (38.8% vs 74.0%; p = 0.002). In contrast, RFS did not differ among patients with low SII and N0/Nx disease (TLNE <6 [49.1%] vs ≥6 [62.4%]; p = 0.099).
High SII was an independent predictor of OND, even among patients with early-stage disease, suggesting that incorporating SII into preoperative risk assessment may refine staging and guide treatment strategies including the need for neoadjuvant therapy as well as the extent and adequacy of LND.
肝内胆管癌（ICC）术前准确诊断淋巴结状态仍具有挑战性。本研究的目的是确定全身免疫炎症指数（SII）是否与接受ICC切除术的cN0患者的隐匿性淋巴结疾病（OND）相关。
从一个国际多机构数据库中识别出接受ICC根治性切除术的患者。采用多变量逻辑回归模型评估SII与OND之间的关系。
在接受cN0 ICC根治性切除术并进行淋巴结清扫（LND）的490例患者中，135例（27.6%）有OND。在这些患者中，高SII（≥738.4）与OND独立相关（比值比[OR]，1.85；95%置信区间[CI]，1.18 - 2.92）。即使在cT1aN0M0疾病患者中，这种关联也一致（OR，1.85；95% CI，1.19 - 2.88）。有趣的是，在高SII和N0/Nx疾病患者中，检查的淋巴结总数（TLNE）少于6个的患者3年无复发生存率（RFS）比TLNE为6个或更多的患者差（38.8%对74.0%；p = 0.002）。相比之下，低SII和N0/Nx疾病患者的RFS没有差异（TLNE <6 [49.1%]对≥6 [62.4%]；p = 0.099）。
高SII是OND的独立预测因素，即使在早期疾病患者中也是如此，这表明将SII纳入术前风险评估可能会优化分期并指导治疗策略，包括新辅助治疗的必要性以及LND的范围和充分性。
