An inflammatory–nutritional score for predicting survival benefit after curative resection for Perihilar cholangiocarcinoma

Abstract

Background Perihilar cholangiocarcinoma (pCCA) is the most common malignancy of the biliary tree. Resection is the only potentially curative treatment for pCCA. Systemic inflammation and nutrition status are sources of important prognostic factors for patients with pCCA. In this study, a risk score, named “neutrophil-albumin-bilirubin (NAB)”, was developed and validated based on inflammation and nutrition status biomarkers for patients with pCCA. Methods A total of 161 patients who underwent surgical resection between December 2008 to April 2016 were included in this retrospective cohort study (118 in the training set and 43 in the validation set). NAB were developed from preoperative blood biomarkers via Least absolute shrinkage and selection operator (LASSO) and Cox regression in training and validation cohorts. Time-dependent receiver operating characteristic curves and Kaplan–Meier analysis were used to verify the prognostic prediction value of the NAB score for resectable pCCA. Nomograms were also established to validate the clinical use of this model for overall survival and recurrence-free survival evaluation. Results Based on albumin–bilirubin (ALBI) grade and neutrophil biomarkers, NAB classified patients into high-risk and low-risk groups when patients with high-risk scores had shorter OS (p < 0.05) and RFS (p < 0.05) than patients with low-risk scores. The relationship between NAB and lymph node metastasis was also claimed(p = 0.004). Furthermore, the high NAB score was a significant independent prognostic factor of OS and RFS in both the training (p = 0.001) and validation (p = 0.037) cohorts, respectively. A NAB-nomogram combined with other independent prognostic factors, like ASA grade, lymph node metastases, perineural invasion and so on, was constructed for individualized prognostic prediction. Conclusion NAB could serve as a robust prognostic biomarker and be helpful for surgical decision-making in patients with pCCA.