Abstract
Background In addition to the clinical parameters, immune-inflammatory markers have emerged as prognostic factors in patients with advanced biliary tract cancer (ABC). The recently proposed A.L.A.N. score combines both in an easily applicable manner. The aim of this study was to perform the first external evaluation of this score. Methods All patients from our clinical registry unit who had unresectable ABC underwent first-line chemotherapy from 2006 to 2018 and met the inclusion criteria of the original study were included (n = 74). The A.L.A.N. score comprises the following parameters: actual neutrophil count, lymphocyte-to-monocyte ratio, albumin, and neutrophil-to-lymphocyte ratio (A.L.A.N.). Univariate and multivariate hazard regression analyses were performed to evaluate the score's parameters regarding overall survival (OS). The concordance index (C-index) and integrated Brier score (IBS) were calculated to evaluate the score's predictive performance. Results Low, intermediate, and high A.L.A.N. scores corresponded to median OS of 21.9, 11.4, and 4.3 months, respectively, resulting in a significant risk stratification (log-rank p=0.017). In multivariate analysis, a high-risk A.L.A.N. score remained an independent predictor of poor survival (p=0.016). Neutrophil-to-lymphocyte ratio was not a significant factor for poor OS in the analyses in the cohort. The score's ability to predict individual patient survival was only moderate with a C-index of 0.63. Conclusions The A.L.A.N. score can be used to identify risk groups with a poor prognosis prior to the start of chemotherapy. However, the ability of the score to predict individual patient outcome was only moderate; thus, it may only serve as a minor component in the complex interdisciplinary discussion.
Highlights
Biliary tract cancer consists of a group of heterogeneous cancer entities deriving from the biliary system, including intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, and gallbladder carcinoma (GBC) [1]. e incidence of biliary tract cancer, which accounts for 3% of all gastrointestinal cancer cases, is relatively low in Western countries, with a range of 0.35–2/100,000 annually [2, 3]
All patients with biliary tract cancer treated at our tertiary care centre were identified with the help of our clinical registry unit (CRU). e development of the study was based on the criteria of the TRIPOD statement [26]
From our CRU, we extracted a total of 349 patients with unresectable advanced biliary tract cancer (ABC), who were treated between January 2006 and June 2018
Summary
Biliary tract cancer consists of a group of heterogeneous cancer entities deriving from the biliary system, including intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), distal cholangiocarcinoma (dCCA), and gallbladder carcinoma (GBC) [1]. e incidence of biliary tract cancer, which accounts for 3% of all gastrointestinal cancer cases, is relatively low in Western countries, with a range of 0.35–2/100,000 annually [2, 3]. Resection remains the only curative option, but it is only available for less than one third of the patients and the majority of patients are diagnosed in advanced stages (advanced biliary tract cancer, ABC) [7, 8]. Considering the poor prognosis of patients with ABC and the potential side effects of aggressive chemotherapy, a risk score providing a priori estimate of survival might have a direct impact on the patient’s assessment regarding treatment options. In addition to the clinical parameters, immune-inflammatory markers have emerged as prognostic factors in patients with advanced biliary tract cancer (ABC). Univariate and multivariate hazard regression analyses were performed to evaluate the score’s parameters regarding overall survival (OS). A high-risk A.L.A.N. score remained an independent predictor of poor survival (p 0.016). E A.L.A.N. score can be used to identify risk groups with a poor prognosis prior to the start of chemotherapy. The ability of the score to predict individual patient outcome was only moderate; it may only serve as a minor component in the complex interdisciplinary discussion
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