• Mohammad Hosein Aziz, Kostandinos Sideras, Nasir Ahmad Aziz, Katya Mauff, Roel Haen, Daphne Roos, Lawlaw Saida, Mustafa Suker, Erwin van der Harst, Jan Sven Mieog, Bert A Bonsing, Yarne Klaver, Koerkamp Bas Groot BG Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands., and Casper H van Eijck.
• Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
• Ann. Surg. 2019 Jul 1; 270 (1): 139-146.

ObjectiveOur 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.BackgroundPancreatic 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.MethodsWe 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.ResultsIn 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.ConclusionsSIII 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.

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