The prognostic significance of the advanced lung cancer inflammation index(ALI) in patients with advanced biliary tract cancer: A retrospective study.

Abstract

e16613 Background: Intrahepatic cholangiocarcinoma is the second most common primary cancer, but the prognosis is poor and aggressive therapies provide only limited benefit when it is in advanced stage. Many studies were conducted to find significant prognostic factors to predict clinical outcomes, but there is no definitive parameter or scoring model yet in this disease. This study is a retrospective analysis to test various kinds of prognostic scoring systems including the advanced lung cancer inflammation (ALI) index, a new prognostic model, for patients treated for advanced intrahepatic cholangiocarcinoma. Methods: We retrospectively searched medical records of patients who were diagnosed with advanced intrahepatic cholangiocarcinoma between January 2012 and December 2017 and actively treated at a single tertiary regional cancer center. Patients who received only supportive care, or had active infection concomitantly were excluded. 60 patients were identified, and we reviewed and analyzed their baseline characteristics and clinical outcomes. Various types of inflammation or nutritional scoring systems, neutrophil to lymphocyte ratio (NLR), Onodera’s prognostic nutritional index (OPNI), the advanced lung cancer inflammation (ALI) index were concurrently calculated and significance for patients’ survival was evaluated. Results: In 50 patients with metastatic stage and 10 patients with locally advanced disease, the median overall survival was 13.97 months (95% confidence interval (CI) 7.99 – 19.95). ALI of 28.5 was determined as the optimal cut-off value for prediction of 1-year survival by receiver operating characteristics (ROC) curve with an AUC value of 0.671 (sensitivity and specificity were 77.8% and 60.6%, respectively). 26 patients with ALI > 28.5 had significantly better overall survival compared with 34 patients with ALI≤28.5 (19.2 months vs. 8.73 months, p= .007). NLR above 2.8 only showed mildly significant difference for overall survival (OS), and the OPNI failed to predict prognosis of these patients. In multivariate analysis, there was no independent prognostic factor observed to have association with overall survival. Conclusions: The advanced lung cancer inflammation (ALI) index showed a potential to be a new prognostic model for advanced intrahepatic cholangiocarcinoma. Further cohort studies to expand population size may be worth.