THE COMBINATION OF BLOOD INFLAMMATORY INDEXES PREDICTS SURVIVALS IN PATIENTS UNDERGOING RESECTION FOR INTRAHEPATIC CHOLANGIOCARCINOMA
Flavio Milana*1,3, Matteo Donadon2,3, Michela Anna Polidoro1, Cristiana Soldani1, Barbara Franceschini1, Guido Torzilli1,3
1IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy; 2Universita degli Studi del Piemonte Orientale Amedeo Avogadro, Vercelli, Piemonte, Italy; 3Humanitas University, Milan, Italy
BACKGROUND
Systemic inflammation is important in the development of intrahepatic cholangiocarcinoma (iCCA). However, controversial results exist on the role of inflammatory scores in patients undergoing resection for iCCA. The aim of this study was to explore the value of different blood inflammatory indexes for predicting the prognosis of resected iCCA patients.
METHODS
A retrospective cohort of patients who underwent hepatic resection for iCCA between January 2010 and January 2021 was analyzed. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) together with all the traditional clinical-pathological prognostic factors were recorded. Cutoff values for NLR, LMR and PLR were calculated by using the Yale X-tile software. Kaplan-Meier and Cox regression analyses were conducted to identify independent prognostic factors.
RESULTS
A total of 101 patients were considered. NLR>3.83 and LMR<2.28 were found to be associated with worse overall survival (OS), while PLR was not. Patients were divided into two groups: 68 (67.3%) patients in the low-risk group (NLR<3.83 and LMR>2.28) and 33 (32.7%) patients in the high-risk group (having at least one or both worse prognostic ratios). After a median follow-up of 44.6 months (IQR 29.6-95.7), the 5-year OS was 22.2% for the low-risk group and 9.0% for high-risk group (P=0.008; Fig.1). At multivariate analysis being more than 65 year-old (HR=2.149; 95%CI=1.086-4.255), elevated Ca19.9 (HR=2.102; 95%CI=1.165-3.793) and being in the high-risk group (HR=1.92; 95%CI=1.045-3.532) were found to be independently associated with worse OS. A patient with elevated Ca19.9 in the high-risk group had 2.063 HR of mortality (P=0.042; Fig.2a) and 2.216 HR of disease recurrence (P=0.007; Fig.2b).
CONCLUSIONS
The combination of blood inflammatory indexes resulted in the identification of two patients' groups with different risk of survival after resection for iCCA. Adding Ca19-9 allows also the identification of patients at increased risk of recurrence.
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