Prognostic Value of Inflammatory and Tumour Markers in Small-Duct Subtype Intrahepatic Cholangiocarcinoma after Curative-Intent Resection

Bingqi Ma,Yuwen Ma,Huijuan Meng,Shiping Li,Qiang Li,Shujuan Zheng,Wei Zhang,An Shen,Dianpeng Zhao,Ye Tian,Guiling Liu,Jose Celso Ardengh

doi:10.1155/2021/6616062

Abstract

Intrahepatic cholangiocarcinoma (ICC) is characterised by heterogeneity, and it can be subdivided into small-duct and large-duct types. Inflammatory and tumour markers could effectively predict prognosis in many cancers, but no similar studies have been conducted in the histological subtypes of ICC. A total of 102 and 72 patients with ICC undergoing curative-intent resection were retrospectively subclassified into large-duct and small-duct types by chemical staining, respectively. The prognostic value of inflammatory and tumour markers was studied for the first time in histological subtypes of ICC by using a Cox regression model. A novel predictor named prognostic inflammatory index (PII) was proposed and defined as neutrophil × monocyte/lymphocyte count (109/L). Survival analysis showed that PII, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), CA242, and ferritin were all predictors of DFS and OS in patients with ICC (P < 0.040). Subgroup analysis showed that PII, CA19-9, and ferritin were risk predictors of disease-free survival (DFS) and overall survival (OS) in small-duct type ICC (P < 0.015). In addition, in small-duct type ICC, NLR and LMR were correlated with OS (P < 0.025), whilst CEA and CA242 were correlated with DFS (P ≤ 0.010). In conclusion, PII is a convenient and efficient inflammatory predictor of DFS and OS in ICCs and their small-duct type. NLR and LMR, rather than platelet-to-lymphocyte ratio, were correlated with OS in small-duct type ICC. In addition, ferritin may be a supplement to CA19-9 in stratifying the survival outcome of patients with small-duct type ICC.

Highlights

Intrahepatic cholangiocarcinoma (ICC) is one of the most frequent primary hepatic malignant tumours behind hepatocellular carcinoma, with an increasing incidence in the last three decades [1]
The results showed that increased neutrophil and prognostic inflammatory index (PII) were independently associated with inferior disease-free survival (DFS) (P = 0:029, hazard ratios (HRs) ð95%CIÞ = 1:791 ð1:063 – 3:017Þ and P = 0:044, HR ð95%CIÞ = 1:904 ð1:017 – 3:563Þ, respectively) and overall survival (OS)
The results showed that carcinoembryonic antigen (CEA) was an independent predictor of DFS in ICCs (P = 0:002, HR ð95% CIÞ = 2:414 ð1:383 – 4:214Þ)

Summary

Introduction

Intrahepatic cholangiocarcinoma (ICC) is one of the most frequent primary hepatic malignant tumours behind hepatocellular carcinoma, with an increasing incidence in the last three decades [1]. Surgical resection remains the main method of potentially curative treatment for patients with ICC. The 5-year overall survival (OS) rate of patients with ICC after curative-intent resection was 18%–. The outcomes of different patients with ICC after surgery vary considerably. The TNM stage is a recognized predictor for patients with ICC, it is difficult to determine accurately before surgery. An efficient and simple biomarker for predicting postoperative survival in ICC is still lacking

Methods

Results

Conclusion