A Novel Biomarker-Based Preoperative Prognostic Grading System for Predicting Survival After Surgery for Intrahepatic Cholangiocarcinoma

Yoh, Tomoaki; Seo, Satoru; Hatano, Etsuro; Taura, Kojiro; Fuji, Hisakazu; Ikeno, Yoshinobu; Okuda, Yasuhiro; Yasuchika, Kentaro; Kaido, Toshimi; Okajima, Hideaki; Üemoto, Shinji

doi:10.1245/s10434-016-5708-z

Cited by 29 publications

(33 citation statements)

References 32 publications

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“…For select patients who undergo curative‐intent surgery, OS generally remains poor with nearly two‐thirds of patients recurring soon after surgery . As such, several prognostic tools have been designed to help practitioners inform patients regarding the long‐term benefit of surgery, as well as to help determine the role of surgical resection as part of multidisciplinary treatment strategy . To date, however, these strategies have focused on the development of risk prediction models at one point in time—either solely based on preoperative factors or through the additional incorporation of postoperative factors.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, preoperative albumin levels, as well as tumor and SIR markers were used to predict postsurgical long‐term outcomes . In a separate study, Yoh et al proposed a preoperative prognostic grading system, which used biomarkers such as NLR, C‐reactive protein (CRP), and CA19‐9 levels, that demonstrated higher accuracy for survival prediction than the AJCC staging systems.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, a preoperative prognostic model should achieve a similar prediction of OS as the postoperative prognostic model. To date, preoperative prognostic models have not been evaluated “head‐to‐head” relative to postoperative prognostic models . In clinical practice, patients and providers routinely reassess prognostic estimates made in the preoperative setting with more refined prognostic estimates in the postoperative setting once the pathology report is back.…”

Section: Discussionmentioning

confidence: 99%

“…The ideal goal of a preoperative prognostic model is to achieve a similar prediction compared with the postoperative prognostic model. Current preoperative prognostic models have not been evaluated “head‐to‐head” relative to postoperative prognostic models . While many parameters are often comparable, including tumor size, number of tumors, and tumor marker levels, patient prognosis may sometimes be disparate in the preoperative and postoperative setting.…”

Section: Introductionmentioning

confidence: 99%

“…7 The TNM staging classification is based on factors obtained postoperatively on the pathologic assessment of the tumor specimen. While several groups have proposed preoperative staging/scoring systems, [8][9][10] preoperative scores usually underestimate or overestimate prognosis compared with the final pathologic assessment of tumors. 11,12 In turn, this may be problematic during preoperative counseling of patients about the relative long-term benefits associated with surgery and, thus, may lead to decisional regret among patients.…”

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confidence: 99%

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Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective

Moro

Paredes

Farooq

et al. 2019

Journal of Surgical Oncology

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Background The objective of the current study was to characterize patients with intrahepatic cholangiocarcinoma (ICC) undergoing curative‐intent surgery with discordant preoperative and postoperative prediction scores and determine factors associated with prediction discrepancy. Methods Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified in a multi‐institutional international database. Preoperative and postoperative prognostic models were designed and discordant prognostic scores were identified. A multivariable logistic regression analysis was completed to determined factors associated with score discordance. Results Among 1149 patients, those who had concordant prediction scores were older (median age, 60 vs 56), and more likely to have a smaller median tumor size (6.0 vs 7.5 cm) (all P < .05). On multivariable logistic analysis, patients with higher neutrophil‐lymphocyte ratio (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09‐1.19), higher CEA levels (OR, 1.25; 95% CI, 1.04‐1.50), larger tumors (OR, 1.10; 95% CI, 1.04‐1.15) and suspicious lymph nodes (OR, 2.05; 95% CI, 1.25‐3.36) were more likely to have preoperative and postoperative score discordance. Older patients had decreased odds of having score discordance (OR, 0.98; 95% CI, 0.96‐0.99). Patients with score discordance had worse overall survival compared with patients with concordant scores (median:15.9 vs 21.7 months, P < .05). Conclusion Score discordance may reflect an aggressive variant of ICC that would benefit from early integration of multidisciplinary treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective

Moro

Paredes

Farooq

et al. 2019

Journal of Surgical Oncology

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Essential updates to the surgical treatment of biliary tract cancer

Matsukuma

Tokumitsu

Shindo

et al. 2019

Annals of Gastroent Surgery

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Biliary tract cancer, which includes intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, gallbladder cancer, and ampullary cancer, is an intractable disease with a dismal prognosis. Prognosis is particularly poor in cases involving vessels or lymph nodes. Hepatobiliary pancreatic surgeons worldwide have consistently focused on improving surgical treatment, perioperative management, and chemotherapy to improve the outcomes of these diseases. There has been significant progress even in the last 2 years (2017 and 2018), such as promising findings reported by studies on the optimal extent of surgical treatment and multi‐institutional randomized controlled trials on adjuvant chemotherapy. We overview the current trends and advancements made in surgical treatment in 2017 and 2018.

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Inflammatory markers in intrahepatic cholangiocarcinoma: Effects of advanced liver disease

et al. 2019

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Background To investigate the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune‐inflammation index (SII) as prognostic biomarkers in intrahepatic cholangiocarcinoma (ICC) with a focus on viral hepatitis and liver status. Methods In this retrospective cohort study, patients from the institutional cancer registry with ICC from 2005 to 2016 were stratified by treatment group. Baseline inflammatory markers were dichotomized at the median. Overall survival (OS) was assessed via Kaplan‐Meier curves and Cox proportional hazard models. Multiple patient, liver, and tumor factors were included in the multivariable analysis (MVA). Results About 131 patients (median age 65 years, 52% male, 76% Caucasian) had a median OS of 13.0 months. Resection/interventional oncology with/without systemic therapy had improved survival vs systemic therapy alone in Child‐Pugh A patients (P < 0.01). In Child‐Pugh B/C patients, this survival difference became nonsignificant (P = 0.22). Increased NLR and SII were associated with decreased survival (P < 0.01), while dichotomized PLR was not (P = 0.3). On MVA, increased NLR remained an independent prognostic factor (HR 1.6, P < 0.05). In Child‐Pugh class A (n = 94), low‐NLR had higher OS vs high‐NLR (25.4 vs 12.2 months, P < 0.01). In Child‐Pugh class B/C (n = 28), NLR did not have a significant effect on median OS (low‐ vs high‐NLR: 6.7 vs 2.9 months, P = 0.2). Child‐Pugh class acted as an effect modifier on MVA for NLR (P = 0.0124). Conclusions The NLR has a stronger impact as a prognostic marker in ICC over the PLR and SII. This survival effect is decreased in advanced liver disease.

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A Novel Biomarker-Based Preoperative Prognostic Grading System for Predicting Survival After Surgery for Intrahepatic Cholangiocarcinoma

Abstract: A novel biomarker-based preoperative prognostic grading system for ICC significantly stratifies survival after surgery and may identify patients requiring further treatment.

Cited by 29 publications

References 32 publications

Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective

Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective

Essential updates to the surgical treatment of biliary tract cancer

Inflammatory markers in intrahepatic cholangiocarcinoma: Effects of advanced liver disease

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