Construction and evaluation of nomogram prognostic model based on preoperative systemic immune-inflammation index and controlling nutritional status score after radical resection of pancreatic ductal adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHAO Quannian , ZHOU Huinian , LI Xiangyang , XIAO Jingying ,  JIAO Zuoyi

Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou 730030, P. R. China;

Corresponding author：

JIAO Zuoyi, Email: jiaozy@lzu.edu.cn

Keywords：

pancreatic ductal adenocarcinoma; systemic immune inflammation index; controlling nutritional status score; nomogram; web calculator

DOI：

10.7507/1007-9424.202104061

Video：

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Objective To explore the factors of affecting the prognosis of pancreatic ductal adenocarcinoma (PDAC) after radical resection based on the preoperative systemic immune-inflammation index (SII) and the controlling nutritional status (CONUT) score and to establish a prognostic prediction model.Methods The clinicopathologic data of patients diagnosed with PDAC from January 2014 to December 2019 in the Second Hospital of Lanzhou University were retrospectively analyzed. The X-tile software was used to determine the optimal cut-off value of SII. The Kaplan-Meier method was used to analyze survival. The Cox proportional hazards regression model was used to conduct multivariate analysis of prognostic factors of PDAC after radical surgery. R4.0.5 software was used to draw a nomogram prediction model of 1-, 2-, and 3-year survival rates, then evaluate the effectiveness of the prediction model and establish a web page calculator.Results A total of 131 patients were included in the study. The median survival time was 18.6 months, and the cumulative survival rates at 1-, 2-, and 3-year were 73.86%, 36.44%, and 11.95%, respectively. The optimal cut-off value of preoperative SII was 313.1, and the prognosis of patients with SII>313.1 was worse than SII≤313.1 (χ²=8.917, P=0.003). The results of multivariate analysis suggested that the age>65 years old, clinical stage Ⅲ and Ⅳ, preoperative SII>313.1, and CONUT score >4 were the independent factors influencing the prognosis (overall survival) for PDAC after radical resection (P<0.05). The internal verification consistency index (C-index) of the nomogram prediction model including age, clinical stage, preoperative SII, CONUT score and postoperative chemotherapy was 0.669. The survival predicted by the nomogram correction curve fitted well with the observed survival. The decision curve analysis showed that the nomogram prediction model had a wider clinical net benefit (Threshold probability was 0.05–0.95), and the web calculator worked well.Conclusions Age, clinical stage, preoperative SII, CONUT score are independent influencing factors for prognosis after radical PDAC surgery. Nomogram prediction model included these independent influencing factors is more accurate and web calculator will be more convenient for doctors and patients.

Citation： SHAO Quannian, ZHOU Huinian, LI Xiangyang, XIAO Jingying, JIAO Zuoyi. Construction and evaluation of nomogram prognostic model based on preoperative systemic immune-inflammation index and controlling nutritional status score after radical resection of pancreatic ductal adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(1): 32-38. doi: 10.7507/1007-9424.202104061 Copy

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4.	Havens JM, Columbus AB, Seshadri AJ, et al. Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients. JPEN J Parenter Enteral Nutr, 2018, 42(1): 156-163.
5.	Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol, 2016, 23(2): 525-533.
6.	Asaoka T, Miyamoto A, Maeda S, et al. Prognostic impact of preoperative NLR and CA19-9 in pancreatic cancer. Pancreatology, 2016, 16(3): 434-440.
7.	Riauka R, Ignatavicius P, Barauskas G. Preoperative platelet to lymphocyte ratio as a prognostic factor for resectable pancreatic cancer: a systematic review and meta-analysis. Dig Surg, 2020, 37(6): 447-455.
8.	Murthy P, Zenati MS, Al Abbas AI, et al. Prognostic value of the systemic immune-inflammation index (SII) After neoadjuvant therapy for patients with resected pancreatic cancer. Ann Surg Oncol, 2020, 27(3): 898-906.
9.	Zhang K, Hua YQ, Wang D, et al. Systemic immune-inflammation index predicts prognosis of patients with advanced pancreatic cancer. J Transl Med, 2019, 17(1): 30.
10.	Aziz MH, Sideras K, Aziz NA, et al. The systemic-immune-inflammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study. Ann Surg, 2019, 270(1): 139-146.
11.	Hong X, Cui B, Wang M, et al. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med, 2015, 236(4): 297-304.
12.	Wang K, Diao F, Ye Z, et al. Prognostic value of systemic immune-inflammation index in patients with gastric cancer. Chin J Cancer, 2017, 36(1): 75.
13.	Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg, 2017, 41(11): 2805-2812.
14.	Ahiko Y, Shida D, Horie T, et al. Controlling nutritional status (CONUT) score as a preoperative risk assessment index for older patients with colorectal cancer. BMC Cancer, 2019, 19(1): 946.
15.	Kuroda D, Sawayama H, Kurashige J, et al. Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer, 2018, 21(2): 204-212.
16.	Jomrich G, Gruber ES, Winkler D, et al. Systemic immune-inflammation index (SII) predicts poor survival in pancreatic cancer patients undergoing resection. J Gastrointest Surg, 2020, 24(3): 610-618.
17.	Shoji F, Haratake N, Akamine T, et al. The preoperative controlling nutritional status score predicts survival after curative surgery in patients with pathological stage Ⅰ non-small cell lung cancer. Anticancer Res, 2017, 37(2): 741-747.
18.	Elinav E, Nowarski R, Thaiss CA, et al. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer, 2013, 13(11): 759-771.
19.	Atsumi T, Singh R, Sabharwal L, et al. Inflammation amplifier, a new paradigm in cancer biology. Cancer Res, 2014, 74(1): 8-14.
20.	Martin HL, Ohara K, Kiberu A, et al. Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer. Intern Med J, 2014, 44(7): 676-682.
21.	Houghton AM, Rzymkiewicz DM, Ji H, et al. Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth. Nat Med, 2010, 16(2): 219-223.
22.	Pillay J, Kamp VM, van Hoffen E, et al. A subset of neutrophils in human systemic inflammation inhibits T cell responses through Mac-1. J Clin Invest, 2012, 122(1): 327-336.
23.	Hilbig A, Oettle H. Transforming growth factor beta in pancreatic cancer. Curr Pharm Biotechnol, 2011, 12(12): 2158-2164.
24.	Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
25.	Mao YS, Hao SJ, Zou CF, et al. Controlling nutritional status score is superior to prognostic nutritional index score in predicting survival and complications in pancreatic ductal adenocarcinoma: a Chinese propensity score matching study. Br J Nutr, 2020, 124(11): 1190-1197.
26.	Li H, Wang Z, Yang F, et al. Development and validation of a nomogram for predicting cancer-specific survival of surgical resected stage Ⅰ–Ⅱ adenosquamous carcinoma of the lung. J Surg Oncol, 2020, 121(6): 1027-1035.

1. Chu LC, Goggins MG, Fishman EK. Diagnosis and detection of pancreatic cancer. Cancer J, 2017, 23(6): 333-342.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin, 2019, 69(1): 7-34.
3. McGuigan A, Kelly P, Turkington RC, et al. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 2018, 24(43): 4846-4861.
4. Havens JM, Columbus AB, Seshadri AJ, et al. Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients. JPEN J Parenter Enteral Nutr, 2018, 42(1): 156-163.
5. Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol, 2016, 23(2): 525-533.
6. Asaoka T, Miyamoto A, Maeda S, et al. Prognostic impact of preoperative NLR and CA19-9 in pancreatic cancer. Pancreatology, 2016, 16(3): 434-440.
7. Riauka R, Ignatavicius P, Barauskas G. Preoperative platelet to lymphocyte ratio as a prognostic factor for resectable pancreatic cancer: a systematic review and meta-analysis. Dig Surg, 2020, 37(6): 447-455.
8. Murthy P, Zenati MS, Al Abbas AI, et al. Prognostic value of the systemic immune-inflammation index (SII) After neoadjuvant therapy for patients with resected pancreatic cancer. Ann Surg Oncol, 2020, 27(3): 898-906.
9. Zhang K, Hua YQ, Wang D, et al. Systemic immune-inflammation index predicts prognosis of patients with advanced pancreatic cancer. J Transl Med, 2019, 17(1): 30.
10. Aziz MH, Sideras K, Aziz NA, et al. The systemic-immune-inflammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study. Ann Surg, 2019, 270(1): 139-146.
11. Hong X, Cui B, Wang M, et al. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med, 2015, 236(4): 297-304.
12. Wang K, Diao F, Ye Z, et al. Prognostic value of systemic immune-inflammation index in patients with gastric cancer. Chin J Cancer, 2017, 36(1): 75.
13. Harimoto N, Yoshizumi T, Sakata K, et al. Prognostic significance of preoperative controlling nutritional status (CONUT) score in patients undergoing hepatic resection for hepatocellular carcinoma. World J Surg, 2017, 41(11): 2805-2812.
14. Ahiko Y, Shida D, Horie T, et al. Controlling nutritional status (CONUT) score as a preoperative risk assessment index for older patients with colorectal cancer. BMC Cancer, 2019, 19(1): 946.
15. Kuroda D, Sawayama H, Kurashige J, et al. Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer, 2018, 21(2): 204-212.
16. Jomrich G, Gruber ES, Winkler D, et al. Systemic immune-inflammation index (SII) predicts poor survival in pancreatic cancer patients undergoing resection. J Gastrointest Surg, 2020, 24(3): 610-618.
17. Shoji F, Haratake N, Akamine T, et al. The preoperative controlling nutritional status score predicts survival after curative surgery in patients with pathological stage Ⅰ non-small cell lung cancer. Anticancer Res, 2017, 37(2): 741-747.
18. Elinav E, Nowarski R, Thaiss CA, et al. Inflammation-induced cancer: crosstalk between tumours, immune cells and microorganisms. Nat Rev Cancer, 2013, 13(11): 759-771.
19. Atsumi T, Singh R, Sabharwal L, et al. Inflammation amplifier, a new paradigm in cancer biology. Cancer Res, 2014, 74(1): 8-14.
20. Martin HL, Ohara K, Kiberu A, et al. Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer. Intern Med J, 2014, 44(7): 676-682.
21. Houghton AM, Rzymkiewicz DM, Ji H, et al. Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth. Nat Med, 2010, 16(2): 219-223.
22. Pillay J, Kamp VM, van Hoffen E, et al. A subset of neutrophils in human systemic inflammation inhibits T cell responses through Mac-1. J Clin Invest, 2012, 122(1): 327-336.
23. Hilbig A, Oettle H. Transforming growth factor beta in pancreatic cancer. Curr Pharm Biotechnol, 2011, 12(12): 2158-2164.
24. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
25. Mao YS, Hao SJ, Zou CF, et al. Controlling nutritional status score is superior to prognostic nutritional index score in predicting survival and complications in pancreatic ductal adenocarcinoma: a Chinese propensity score matching study. Br J Nutr, 2020, 124(11): 1190-1197.
26. Li H, Wang Z, Yang F, et al. Development and validation of a nomogram for predicting cancer-specific survival of surgical resected stage Ⅰ–Ⅱ adenosquamous carcinoma of the lung. J Surg Oncol, 2020, 121(6): 1027-1035.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Construction and evaluation of nomogram prognostic model based on preoperative systemic immune-inflammation index and controlling nutritional status score after radical resection of pancreatic ductal adenocarcinoma

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