Clinical Value of Inflammation-Based Prognostic Scores to Predict the Resectability of Hyperbilirubinemia Patients with Potentially Resectable Hilar Cholangiocarcinoma

• Published in: Journal of gastrointestinal surgery Vol. 23; no. 3; pp. 510 - 517
• Main Authors: Hu, Hai-Jie, Jin, Yan-Wen, Zhou, Rong-Xing, Ma, Wen-Jie, Yang, Qin, Wang, Jun-Ke, Liu, Fei, Cheng, Nan-Sheng, Li, Fu-Yu
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2019; Springer Nature B.V
• Subjects: Adult; Aged; Bile Duct Neoplasms - blood; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Blood Cell Count; Cholangiocarcinoma; Female; Gastroenterology; Gastrointestinal surgery; Humans; Hyperbilirubinemia - etiology; Hyperbilirubinemia - pathology; Hyperbilirubinemia - surgery; Inflammation; Klatskin Tumor - blood; Klatskin Tumor - pathology; Klatskin Tumor - surgery; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Nutrition Assessment; Original Article; Patient Selection; Predictive Value of Tests; Prognosis; Surgery; Treatment Outcome; Tumors; Tumor resectability; Prognosis; Hilar cholangiocarcinoma; Inflammation-based prognostic score
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3892-9

Background We aimed to examine whether inflammation-based prognostic scores could predict tumor resectability in a cohort of hilar cholangiocarcinoma patients with preoperative hyperbilirubinemia. We also sought to investigate the prognostic factors associated with overall survival in the subgroup of patients with an R0 resection. Methods A total of 173 patients with potentially resectable hilar cholangiocarcinoma, as judged by radiological examinations, were included. The potential relationship of the Glasgow prognostic score (GPS), modified GPS, platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI) with tumor resectability were investigated using univariate and multivariate analysis. Results Among the 173 patients, 134 had R0 resection margins. Univariate analysis identified that patients with PLR ≥ 150, NLR ≥ 3, PNI ≥ 45, GPS (0.1/2), modified GPS (0.1/2), preoperative CA 125 > 35 U/mL, and a tumor size ≥ 3 cm were more likely to have unresectable tumors. Multivariate analysis indicated that tumor size ≥ 3 cm (OR = 2.422, 95% CI: 1.053–5.573; P  = 0.037), PLR ≥ 150 (OR = 3.324, 95% CI: 1.143–9.667; P  = 0.027), preoperative CA 125 > 35 U/mL (OR = 3.184, 95% CI: 1.316–7.704; P  = 0.010), and GPS (0.1/2) (OR = 2.440, 95% CI: 1.450–4.107; P  = 0.001) were independent factors associated with tumor resectability. In selected patients with an R0 resection in this cohort, nodal status ( P  = 0.010) and tumor differentiation ( P  = 0.025) were predictive of poor survival outcome. Conclusion Patients with higher GPS, CA 125, and PLR levels, and a larger tumor size, tend to have unresectable tumors even if they were judged as potentially resectable using preoperative radiological examinations.