Abstract
BackgroundThe objective of our research was to investigate the value of the lymphocyte to monocyte ratio (LMR) and its dynamic changes (LMRc) in predicting tumor resectability and early recurrence of radiologically resectable type IV hilar cholangiocarcinoma (HC). MethodsA total of 411 patients with radiologically resectable type IV HC were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. Receiver operating characteristic (ROC) analysis was conducted to assess the ability of preoperative LMR (pre-LMR) to predict tumor resectability, and the ability of postoperative LMR (post-LMR) to discriminate between early and late recurrence. Survival curves were calculated using the Kaplan–Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with resectability and early recurrence. ResultsOf 411 patients with potentially curative type IV HC, 254 underwent curative surgery. The optimal cutoff value of pre-LMR as an indicator of resectability was 3.67, and the optimal cutoff value of post-LMR for detecting early recurrence was 4.10. In the multivariate logistic regression model, CA19-9 > 200 U/mL, pre-LMR ≤ 3.67, and tumor size > 3 cm were found to be independent risk factors for poor resectability. Moreover, multivariate analysis showed that LMRc, resection margin, AJCC N stage, and lymphovascular invasion were independent risk factors associated with early recurrence. DiscussionPre-LMR is a valuable indicator of resectability and LMRc is a valuable predictor of early recurrence in patients with curative type IV HC.
Highlights
Hilar cholangiocarcinoma (HC) is a lesion that arises from the biliary confluence and has a strong tendency to infiltrate into adjacent structures, such as the liver parenchyma, hepatic artery, portal vein, peripheral nerve system, and the bile duct.[1]
An increasing amount of research has been focusing on the effects of systemic inflammatory response (SIR) on oncogenesis, and such research has revealed that there is a significant relationship between SIR and poor tumor-specific survival in numerous cancers.[9,10,11]
The neutrophil to lymphocyte ratio (NLR), which is considered as a biomarker of SIR, has emerged as an independent prognostic factor for biliary tract cancer in operable patients and in advanced disease patients undergoing adjuvant therapy.[12, 13]
Summary
Hilar cholangiocarcinoma (HC) is a lesion that arises from the biliary confluence and has a strong tendency to infiltrate into adjacent structures, such as the liver parenchyma, hepatic artery, portal vein, peripheral nerve system, and the bile duct.[1]. The current study was conducted to determine whether LMR could be used to predict the resectability and early recurrence rates of radiologically resectable type IV HC. The objective of our research was to investigate the value of the lymphocyte to monocyte ratio (LMR) and its dynamic changes (LMRc) in predicting tumor resectability and early recurrence of radiologically resectable type IV hilar cholangiocarcinoma (HC). Methods A total of 411 patients with radiologically resectable type IV HC were included Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. In the multivariate logistic regression model, CA19-9 > 200 U/mL, pre-LMR ≤ 3.67, and tumor size > 3 cm were found to be independent risk factors for poor resectability. Multivariate analysis showed that LMRc, resection margin, AJCC N stage, and lymphovascular invasion were independent risk factors associated with early recurrence.
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