Tianyang Mao,1– 3,* Xin Zhao,1,2,* Kangyi Jiang,1,2 Qingyun Xie,4 Manyu Yang,1– 3 Hongyuan Wang,1– 3 Peng Zheng,1– 3 Zehua Lei,1,2 Fengwei Gao1,2,4 

1Department of Hepatobiliary Surgery, The People’s Hospital of Leshan, Leshan, People’s Republic of China; 2Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, People’s Republic of China; 3North Sichuan Medical College, Nanchong, People’s Republic of China; 4Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Fengwei Gao, Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China, Tel + 86 18990609527, Email Gaofengweigfw8@126.com

Purpose: The occurrence and progression of hepatolithiasis are related to inflammatory reactions and immune proteins. This study aims to evaluate the relationship between systemic immune index (SII) in recurrence-free survival (RFS), as well as the incidence of severe postoperative complications in hepatolithiasis patients.
Patients and Methods: We retrospectively analyzed 177 patients with hepatolithiasis. The optimal cut-off values of SII, systemic inflammatory response index (SIRI), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) and prognostic nutritional index (PNI) were evaluated by the analysis of the receiver operating characteristic (ROC) curve. The relationship between SII, SIRI, NLR and clinical results was tested with χ²-test. Logical regression analysis is used to evaluate the risk factors of postoperative serious complications. The Kaplan-Meier survival curve and Cox regression analyses are used to evaluate the impact of SII, SIRI, NLR on RFS.
Results: The analysis of the ROC curve determines the optimal cut-off value and the area under the curve (AUC) of SII, SIRI, NLR, MLR, PLR and PNI, and then grouped. In the multivariate analysis, surgical method (HR=3.331, 95% CI: 1.360– 8.158, p=0.008) and SII (HR=2.883, 95% CI: 1.084– 7.668, p=0.034) were identified as independent risk factors for serious postoperative complications; the multivariate cox regression analysis demonstrated that a history of gallstones (HR=1.965, 95% CI: 1.206– 3.201, p=0.007), SII (HR=2.818, 95% CI: 1.340– 5.926, p=0.006), and MLR (HR=3.240, 95% CI: 1.158– 9.067, p=0.025) were independent risk factors for RFS; survival analysis results show that patients with low levels of SII (p< 0.001), SIRI (p=0.005), and NLR (p< 0.001) had significantly higher RFS compared to those in the high-level group.
Conclusion: Preoperative high levels of SII, SIRI, and NLR are associated with postoperative recurrence in patients with hepatolithiasis, with SII identified as an independent risk factor for both postoperative RFS and serious complications.

Keywords: hepatolithiasis, systemic immune index, systemic inflammatory response index, recurrence-free survival, postoperative complications, predict