Construction and validation of a novel prognostic model for intrahepatic cholangiocarcinoma based on a combined scoring system of systemic immune-inflammation index and albumin-bilirubin: a multicenter study

Abstract

BackgroundThe degree of inflammation and immune status is widely recognized to be associated with intrahepatic cholangiocarcinoma (ICC) and is closely linked to poor postoperative survival. The purpose of this study was to evaluate whether the systemic immune-inflammatory index (SII) and the albumin bilirubin (ALBI) grade together exhibit better predictive strength compared to SII and ALBI separately in patients with ICC undergoing curative surgical resection.MethodsA retrospective analysis was performed on a cohort of 374 patients with histologically confirmed ICC who underwent curative surgical resection from January 2016 to January 2020 at three medical centers. The cohort was divided into a training set comprising 258 patients and a validation set consisting of 116 patients. Subsequently, the prognostic predictive abilities of three indicators, namely SII, ALBI, and SII+ALBI grade, were evaluated. Independent risk factors were identified through univariate and multivariate analyses. The identified independent risk factors were then utilized to construct a nomogram prediction model, and the predictive strength of the nomogram prediction model was assessed through Receiver Operating Characteristic (ROC) survival curves and calibration curves.ResultsUnivariate analysis of the training set, consisting of 258 eligible patients with ICC, revealed that SII, ALBI, and SII+ALBI grade were significant prognostic factors for overall survival (OS) and recurrence-free survival (RFS) (p < 0.05). Multivariate analysis revealed the independent significance of SII+ALBI grade as a risk factor for postoperative OS and RFS (p < 0.05). Furthermore, we conducted an analysis of the correlation between SII, ALBI, SII+ALBI grade, and clinical features, indicating that SII+ALBI grade exhibited stronger associations with clinical and pathological characteristics compared to SII and ALBI. We constructed a predictive model for postoperative survival in ICC based on SII+ALBI grade, as determined by the results of multivariate analysis. Evaluation of the model’s predictive strength was performed through ROC survival curves and calibration curves in the training set and validation set, revealing favorable predictive performance.ConclusionThe SII+ALBI grade, a novel classification based on inflammatory and immune status, serves as a reliable prognostic indicator for postoperative OS and RFS in patients with ICC.

The fibrosis-4 index is a prognostic factor for cholangiocarcinoma patients who received immunotherapy

“…In our study, bilirubin levels within a week before receiving immunotherapy were related to the total survival time of the patients (mOS: 1508 vs. 263 days), with higher levels indicating a worse prognosis. Bilirubin levels affect patients with cholangiocarcinoma's prognosis in several ways: Patients with hilar cholangiocarcinoma with higher bilirubin levels at diagnosis may not benefit from surgery (34); The albumin bilirubin (ALBI) grade, which combines bilirubin and albumin levels, is an independent prognostic factor for OS and PFS in intrahepatic cholangiocarcinoma (35,36). The analysis of FIB-4, SII, NLR, PLR, and PNI showed that FIB-4 is an independent risk factor for OS in patients with cholangiocarcinoma undergoing immunotherapy.…”