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Abstract
BackgroundCumulating evidence indicates that the systemic inflammatory response (SIR) plays a crucial role in the prognosis of various cancers. We aimed to generate a preoperative risk grade (PRG) by integrating SIR markers to preoperatively predict the long-term prognosis of intrahepatic cholangiocarcinoma (ICC).Methods468 consecutive ICC patients who underwent hepatectomy between 2010 and 2017 were enrolled. The PRG and a nomogram were generated and their predictive accuracy was evaluated.ResultsThe PRG consisted of two non-tumor-specific SIR markers platelet-to-lymphocyte ratio (PLR) and albumin (ALB), which were both the independent predictors of overall survival (OS). Multivariate analysis showed that the PRG was significantly associated with OS (PRG = 1: hazard ratio (HR) = 3.800, p < 0.001; PRG = 2: HR = 7.585, p < 0.001). The C-index of the PRG for predicting survival was 0.685 (95% CI 0.655 to 0.716), which was statistically higher than that of the following systems: American Joint Committee on Cancer (AJCC) 8th edition (C-index 0.645), Liver Cancer Study Group of Japan (LCSGJ) (C-index 0.644) and Okabayashi (C-index 0.633) (p < 0.05). Besides, the C-index of the nomogram only consisting of the tumor-specific factors (serum carcinoembryonic antigen, carbohydrate antigen 19-9, tumor number) could be improved to 0.737 (95% CI 0.062–0.768) from 0.625 (95% CI 0.585–0.665) when the PRG was incorporated (p < 0.001).ConclusionsThe PRG integrating two non-tumor-specific SIR markers PLR and ALB was a novel method to preoperative predicting the prognosis of ICC.
Highlights
Cumulating evidence indicates that the systemic inflammatory response (SIR) plays a crucial role in the prognosis of various cancers
Several studies have described some prognostic factors and developed the relative staging systems for classification of intrahepatic cholangiocarcinoma (ICC) to provide the information of anticipated long-term outcomes, no one has had the excellent prognostic discrimination of ICC [2]
Surgical resection procedure The indications for liver resection in our center included that the liver function was Child–Pugh class A or class B, the tumors was resectable based on the preoperative imaging and the residual liver volume was enough predicted by volumetric computed tomography (CT) [16]
Summary
Cumulating evidence indicates that the systemic inflammatory response (SIR) plays a crucial role in the prognosis of various cancers. We aimed to generate a preoperative risk grade (PRG) by integrating SIR markers to preoperatively predict the long-term prognosis of intrahepatic cholangiocarcinoma (ICC). Complete surgical resection remains the only potentially curative treatment. Only about 20% to 40% of ICC patients have the chance to receive surgical resection and the prognosis is unsatisfactory, with a median survival ranging from 24 to 36 months [3, 5]. Several studies have described some prognostic factors and developed the relative staging systems for classification of ICC to provide the information of anticipated long-term outcomes, no one has had the excellent prognostic discrimination of ICC [2]. What’s more, the majority of these factors are tumorspecific pathologic markers, which are only available after surgery [7, 8]
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