Abstract
BackgroundIn the surgical treatment of intrahepatic cholangiocarcinoma (ICC), postoperative complications may be predictive of long-term survival. This study aimed to identify an immune-nutritional index (INI) that can be used for preoperative prediction of complications.Patients and methodsMulti-institutional data from 316 patients with ICC who had undergone surgical resection were retrospectively analysed, with a focus on various preoperative INIs.ResultsSevere complications (Clavien-Dindo grade III–V) were identified in 66 patients (20.8%), including Grade V complications in 7 patients (2.2%). Comparison of areas under the receiver operating characteristic curve (AUCs) among various INIs identified the prognostic nutritional index (PNI) as offering the highest predictive value for severe complications (AUC = 0.609, cut-off = 50, P = 0.008). Multivariate analysis revealed PNI < 50 (odds ratio [OR] = 2.22, P = 0.013), hilar lesion (OR = 2.46, P = 0.026), and long operation time (OR = 1.003, P = 0.029) as independent risk factors for severe complications. In comparing a high-PNI group (PNI ≥ 50, n = 142) and a low-PNI group (PNI < 50, n = 174), the low-PNI group showed higher rates of both major complications (27% vs. 13.4%; P = 0.003) and infectious complications (14.9% vs. 3.5%; P = 0.0021). Furthermore, median survival time and 1- and 5-year overall survival rates were 34.2 months and 77.4 and 33.8% in the low-PNI group, respectively, and 52.4 months and 89.3 and 47.5% in the high-PNI group, respectively (P = 0.0017).ConclusionPreoperative PNI appears useful as an INI correlating with postoperative severe complications and as a prognostic indicator for ICC.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary cancer of the liver, and arises from the intrahepatic bile ducts [1, 2]
We retrospectively examined the medical records of 316 patients and evaluated preoperative prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and controlling nutritional status
Patients and methods We retrospectively examined the medical records of 415 patients with intrahepatic cholangiocarcinoma (ICC) who underwent curative surgical resection at 17 institutions in Japan between January 2000 and December 2016
Summary
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary cancer of the liver, and arises from the intrahepatic bile ducts [1, 2]. The surgical approach typically involves liver resection with en bloc resection of regional lymph nodes. This represents one of the most invasive surgical procedures for the treatment of a gastrointestinal cancer. Gaya et al reported on postoperative complications as independent predictors of poor long-term survival in patients with ICC [5]. In the surgical treatment of intrahepatic cholangiocarcinoma (ICC), postoperative complications may be predictive of long-term survival. This study aimed to identify an immune-nutritional index (INI) that can be used for preoperative prediction of complications
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