Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Preoperative neutrophil-to-lymphocyte ratio is prognostic for early recurrence after curative intrahepatic cholangiocarcinoma resection

  • Woo Jin Choi (Department of Surgery, University of Toronto) ;
  • Fiorella Murillo Perez (Toronto Center for Liver Disease, University Health Network) ;
  • Annabel Gravely (Toronto Center for Liver Disease, University Health Network) ;
  • Tommy Ivanics (HPB Surgical Oncology, University Health Network) ;
  • Marco P. A. W. Claasen (HPB Surgical Oncology, University Health Network) ;
  • Liza Abraham (Department of Surgery, University of Toronto) ;
  • Phillipe Abreu (HPB Surgical Oncology, University Health Network) ;
  • Robin Visser (HPB Surgical Oncology, University Health Network) ;
  • Steven Gallinger (Department of Surgery, University of Toronto) ;
  • Bettina E. Hansen (Toronto Center for Liver Disease, University Health Network) ;
  • Gonzalo Sapisochin (Department of Surgery, University of Toronto)
  • Received : 2022.11.14
  • Accepted : 2022.12.27
  • Published : 2023.05.31
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Abstract

Backgrounds/Aims: Within two years of surgery, 70% of resected intrahepatic cholangiocarcinoma (iCCA) recur. Better biomarkers are needed to identify those at risk of "early recurrence" (ER). In this study, we defined ER and investigated whether preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic-inflammatory index were prognostic of both overall relapse and ER after curative hepatectomy for iCCA. Methods: A retrospective cohort of patients who underwent curative-intent hepatectomy for iCCA between 2005 and 2017 were created. The cut-off timepoint for the ER of iCCA was estimated using a piecewise linear regression model. Univariable analyses of recurrence were conducted for the overall, early, and late recurrence periods. For the early and late recurrence periods, multivariable Cox regression with time-varying regression coefficient analysis was used. Results: A total of 113 patients were included in this study. ER was defined as recurrence within 12 months of a curative resection. Among the included patients, 38.1% experienced ER. In the univariable model, a higher preoperative NLR (> 4.3) was significantly associated with an increased risk of recurrence overall and in the first 12 months after curative surgery. In the multivariable model, a higher NLR was associated with a higher recurrence rate overall and in the ER period (≤ 12 months), but not in the late recurrence period. Conclusions: Preoperative NLR was prognostic of both overall recurrence and ER after curative iCCA resection. NLR is easily obtained before and after surgery and should be integrated into ER prediction tools to guide preoperative treatments and intensify postoperative follow-up.

Keywords

Acknowledgement

Woo Jin Choi has been supported by the Canadian Institutes of Health Research (CIHR) (FRN: 181365, 2022) for his PhD studies.

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