Prognostic Value of the Preoperative Systemic Immune-Inflammation Index for Overall Survival After Surgical Resection for Gallbladder Cancer: A Systematic Review and Meta-Analysis.
Mohammadsadra Shamohammadi, Armaghan Abbasi Garavand, Kimia Jalalian Rad et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether preoperative systemic immune-inflammation index (SII) is associated with overall survival after gallbladder cancer resection. Seven retrospective cohorts included 2,153 patients; six cohorts with 2,067 patients contributed comparable high-versus-low SII estimates to the primary analysis. Higher SII was associated with poorer overall survival, with a pooled hazard ratio of 2.06 (95% CI 1.70-2.51; I² = 3.6%). The association persisted in analyses restricted to multivariable-adjusted estimates. The authors conclude that prospective evaluation and independent external validation are needed before establishing SII’s incremental value for risk stratification.
Key findings
- Across six studies and 2,067 patients, higher versus lower preoperative SII was associated with poorer overall survival (pooled HR 2.06; 95% CI 1.70-2.51; I² = 3.6%).
- In five studies reporting multivariable-adjusted estimates, the association remained significant (pooled adjusted HR 2.10; 95% CI 1.39-3.20; I² = 22.0%).
- The supplementary univariable analysis also found poorer survival with higher SII (pooled HR 3.11; 95% CI 1.68-5.75; I² = 75.2%).
Why it matters
The findings suggest that a preoperative measure reflecting systemic inflammation and immune balance may help identify patients with gallbladder cancer who have poorer survival after resection. The consistency of the primary and adjusted analyses supports further study of SII as a prognostic marker, while the evidence does not establish that it adds useful information beyond existing clinical risk assessment.
What to keep in mind
The evidence came from retrospective cohorts, and the authors state that SII’s incremental value requires prospective evaluation and independent external validation. The univariable analysis also showed substantial heterogeneity (I² = 75.2%).