Abstract
BackgroundThe preoperative nutritional status and the immunological status have been reported to be independent prognostic factors of patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to investigate whether prognostic nutritional index (PNI) + albumin–bilirubin (ALBI) could be a better predictor than PNI and ALBI alone in patients with ICC after radical resection.MethodsThe prognostic prediction evaluation of the PNI, ALBI, and the PNI+ALBI grade was performed in 373 patients with ICC who underwent radical resection between 2010 and 2018 at six Chinese tertiary hospitals, and external validation was conducted in 162 patients at four other Chinese tertiary hospitals. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan–Meier method. Multivariate analysis was conducted to identify independent prognostic factors. A time-dependent receiver operating characteristic (ROC) curve and a nomogram prediction model were further constructed to assess the predictive ability of PNI, ALBI, and the PNI+ALBI grade. The C-index and a calibration plot were used to assess the performance of the nomogram models.ResultsUnivariate analysis showed that PNI, ALBI, and the PNI+ALBI grade were prognostic factors for the OS and RFS of patients with ICC after radical resection in the training and testing sets (p < 0.001). Multivariate analysis showed that the PNI+ALBI grade was an independent risk factor for OS and RFS in the training and testing sets (p < 0.001). Analysis of the relationship between the PNI+ALBI grade and clinicopathological characteristics showed that the PNI+ALBI grade correlated with obstructive jaundice, alpha-fetoprotein (AFP), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), PNI, ALBI, Child–Pugh grade, type of resection, tumor size, major vascular invasion, microvascular invasion, T stage, and N stage (p < 0.05). The time-dependent ROC curves showed that the PNI+ALBI grade had better prognostic predictive ability than the PNI, ALBI, and the Child–Pugh grade in the training and testing sets.ConclusionPreoperative PNI+ALBI grade is an effective and practical predictor for the OS and RFS of patients with ICC after radical resection.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common biliary malignancy and accounts for about 10%–15% of primary liver carcinoma [1, 2]
Albumin–bilirubin (ALBI) was first attempted to assess the liver function reserve of patients diagnosed with hepatocellular carcinoma (HCC) the same as the Child–Pugh grade in 2015, but ALBI had better predictive ability than the Child–Pugh grade for postoperative liver failure and long-term survival of patients undergoing liver resection [7, 8]
Several recent studies have demonstrated that the prognostic nutritional index (PNI) and ALBI are closely related to the prognosis of patients with HCC, ICC, and gallbladder cancer [8–13]
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common biliary malignancy and accounts for about 10%–15% of primary liver carcinoma [1, 2]. Several recent studies have demonstrated that the PNI and ALBI are closely related to the prognosis of patients with HCC, ICC, and gallbladder cancer [8–13]. Both the preoperative nutritional status and the immunological status have been reported to be independent prognostic factors of patients with ICC [11, 14–16]. This study aimed to investigate whether the PNI+ALBI grade could be a better predictor than PNI and ALBI alone in patients with ICC after radical resection. This study aimed to investigate whether prognostic nutritional index (PNI) + albumin–bilirubin (ALBI) could be a better predictor than PNI and ALBI alone in patients with ICC after radical resection
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