Abstract
PURPOSE: Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive malignancy with limited treatment options, often diagnosed at advanced stages. Radioembolization has emerged as a promising therapy, but its efficacy varies among patients, necessitating reliable biomarkers to predict treatment response. This study evaluates the prognostic impact of systemic inflammatory response markers on treatment outcomes in patients with iCCA undergoing radioembolization. METHODS: This retrospective study included 70 patients with iCCA treated with radioembolization between January 2016 and December 2023. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were measured from peripheral blood samples. Treatment response was assessed using the modified RECIST criteria, and survival analyses were performed using the Kaplan–Meier method and Cox proportional hazards regression. RESULTS: Patients with lower NLR, PLR, and SII values exhibited significantly higher objective response rates (P = 0.032, P = 0.016, and P = 0.001, respectively). High levels of NLR, PLR, and SII were associated with shorter overall survival (12 vs. 16 months, P = 0.007; 12 vs. 16 months, P = 0.004; and 10 vs. 22 months, P < 0.001, respectively) and progression-free survival (3 vs. 7 months, P = 0.046 for SII). Multivariate analysis identified high SII (P = 0.040), lymph node metastasis (P = 0.042), and high serum total bilirubin (P = 0.013) as significant independent prognostic factors. CONCLUSION: Systemic inflammatory markers such as NLR, PLR, and SII are valuable prognostic indicators for patients with iCCA undergoing radioembolization. These markers can aid in identifying patients likely to benefit from personalized treatment strategies, potentially improving clinical outcomes. CLINICAL SIGNIFICANCE: The clinical significance of this study lies in its demonstration that systemic inflammatory markers (NLR, PLR, and SII) serve as valuable prognostic indicators for predicting treatment outcomes in patients with iCCA undergoing radioembolization, thus aiding in the identification of patients who may benefit from personalized treatment strategies and potentially improving clinical outcomes.