Neutrophil‑to‑lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma

Abstract

Systemic inflammatory-, immunological- and nutritional-based indices, such as the neutrophil-to-lymphocyte ratio (NLR), the prognostic nutritional index (PNI) and the Glasgow prognostic score (GPS), are drawing considerable research attention to predict the long-term prognosis of many types of cancer. Recently, these parameters have also been reported to be useful in predicting postoperative morbidity in several fields, including colorectal and otolaryngological cancer. However, while distal cholangiocarcinoma exhibits a high morbidity rate, its risk factors of morbidity have not yet been established. This is because previous studies have analyzed distal cholangiocarcinoma as periampullary tumors combined with pancreatic head cancer. Therefore, the aim of the present study was to investigate the application of the NLR, the PNI and the GPS in evaluating risk factors for postoperative morbidity in patients with distal cholangiocellular or ampullary carcinoma. Eighty-four patients who underwent pancreaticoduodenectomy (PD) for distal cholangiocellular or ampullary carcinoma at the Department of Surgery in Kitasato University Hospital between 2008 and 2016 were enrolled. Associations between perioperative characteristics (NLR, PNI and GPS) and postoperative complications (Clavien-Dindo classification grade III or higher) were retrospectively analyzed. In the univariate analysis, neutrophil and lymphocyte counts, body mass index (BMI) and the NLR were associated with postoperative complications (P<0.05). In the multivariate analysis, BMI [>23.0 kg/m2; odds ratio (OR): 3.80, 95.0% confidence interval (CI): 1.35–11.83; P=0.011] and the NLR (>2.0; OR: 6.77, 95.0% CI: 2.44–21.13; P<0.001) were independent risk factors for postoperative complications. BMI and the NLR are valuable predictors of postoperative morbidity following PD in patients with distal cholangiocarcinoma. It would be beneficial to determine treatment strategies for distal cholangiocarcinoma based on the NLR to reduce postoperative complications.

Pancreaticoduodenectomy in a patient with intestinal malrotation and distal cholangiocarcinoma: a case report and review of the literature

“…During PD, arterial anomalies can increase the operative complexity of surgery, which is determined by the course of these arteries, but they do not usually compromise the safety of the procedure or its oncological outcome [13]. Body mass index, neutrophil-to-lymphocyte ratio, margin status, locoregional lymph node metastases, and the use of chemotherapy are the most important determinants of postsurgical outcomes [9,14,15].…”

Plasma desacyl ghrelin‑to‑acyl ghrelin ratio is a predictor of postoperative complications and prognosis after pancreaticoduodenectomy

“…In the present study, PNI and HS-GPS were not independent factors in the analyses of risk factors of morbidity and mortality. Depending on the control of obstructive jaundice and cholangitis, the high inflammatory state can last and progress to malnutrition and weight loss (31). It is speculated that the relatively good control of jaundice and cholangitis in the present study patients affected the analyses between the PNI and HS-GPS and outcomes.…”

Prognostic Power of Inflammatory Response Scoring Systems in Periampullary Pancreatic Cancer: A Systematic Review

“…Kumamoto et al assessed 84 patients and found that the GPS did not accurately predict postoperative major complications. [12] Four studies evaluated NLR in patients with PPC. [10,[12][13][14] Garcea et al demonstrated that NLR has no pre-operative value in discriminating between operable and non-operable disease and has no value in detecting occult disease.…”

“…[10] Kumamoto et al found that a higher NLR as associated with major complications. [12] Hamed et al evaluated the use of NLR in 74 patients with periampullary tumours; they demonstrated that the median survival between patients having NLR >5 and <5 was not significantly different; however, in patients developing recurrence, NLR <5 was associated with improved survival. [13] Demirci et al found that an NLR of more than 3 was associated with overall survival and disease-free survival.…”