Abstract
Simple SummaryBiliary tract cancers (BTCs) are a heterogeneous group of malignancies, which arise from the epithelial cells of the biliary tree, with a high rate of local invasion and metastatic spreading. Surgical resection remains the treatment which offers the best chance of long-term survival. However, new chemotherapy regimens and multimodal strategies have showed encouraging results, supporting the need for simple and readily available preoperative tools able to predict survival and guide the treatment strategy. Recently, the prognostic role of several nutritional and inflammatory indexes in growth, biological aggressiveness, and spread has been investigated in different types of cancers. Nevertheless, complete and conclusive results on BTCs are lacking. By identifying a preoperative immune and inflammatory prognostic index based on simple routine blood samples, we may have an additional element that is useful in guiding the treatment strategy by assigning selected patients to preoperative or postoperative treatments despite pathological results.The relationship between immune-nutritional status and tumor growth; biological aggressiveness and survival, is still debated. Therefore, this study aimed to evaluate the prognostic performance of different inflammatory and immune-nutritional markers in patients who underwent surgery for biliary tract cancer (BTC). The prognostic role of the following inflammatory and immune-nutritional markers were investigated: Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), Prognostic Nutritional Index (PNI). A total of 282 patients undergoing surgery for BTC were included. According to Cox regression and ROC curves analysis for survival, LMR had the best prognostic performances, with hazard ratio (HR) of 1.656 (p = 0.005) and AUC of 0.652. Multivariable survival analysis identified the following independent prognostic factors: type of BTC (p = 0.002), T stage (p = 0.014), N stage (p < 0.001), histological grading (p = 0.045), and LMR (p = 0.025). Conversely, PNI was related to higher risk of severe morbidity (p < 0.001) and postoperative mortality (p = 0.005). In conclusion, LMR appears an independent prognostic factor of long-term survival, whilst PNI seems associated with worse short-term outcomes.
Highlights
Biliary tract cancers (BTCs) are the second most common hepatobiliary malignancy worldwide, representing about 3% of all gastrointestinal tumors [1]
Patients submitted to radical intent surgery, pathologically confirmed BTC, and with follow-up >6 months were enrolled in the current study
Biliary tract cancers were classified according to the 3rd English edition of the Japanese classification of biliary tract cancers [2], as intrahepatic cholangiocarcinoma (ICC), perihilar cholangiocarcinoma (PCC), distal cholangiocarcinoma (DCC), and gallbladder cancer (GBC), and were staged according to the American Joint Committee against Cancer (AJCC)
Summary
Biliary tract cancers (BTCs) are the second most common hepatobiliary malignancy worldwide, representing about 3% of all gastrointestinal tumors [1]. According to the site of origin, they are classified as intrahepatic cholangiocarcinoma (ICC) arising from intrahepatic bile ducts, perihilar cholangiocarcinoma (PCC) arising or involving the hepatic biliary confluence, distal cholangiocarcinoma (DCC) arising from the bile duct distal to the cystic duct origin, and gallbladder cancer (GBC) [2]. Regardless of their location, BTCs are very aggressive diseases, with a high rate of local invasion and metastatic spreading. The encouraging results of new chemotherapy regimens and multimodal strategies support the need for simple and readily available preoperative tools, able to predict survival and guide the treatment strategy [7,8,9]
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