Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium

Beal, Eliza W.; Wei, Lai; Ethun, Cecilia G.; Black, Sylvester M.; Dillhoff, Mary; Salem, Ahmed; Weber, Sharon M.; Tran, Thuy B.; Poultsides, George A.; Son, Andre Y.; Hatzaras, Ioannis; Jin, Linda X.; Fields, Ryan C.; Buettner, Stefan; Pawlik, Timothy M.; Scoggins, Charles R.; Martin, Robert C.G.; Isom, Chelsea A.; Idrees, Kamron; Mogal, Harveshp; Shen, Perry; Maithel, Shishir K.; Schmidt, Carl

doi:10.1016/j.hpb.2016.08.006

Cited by 47 publications

(42 citation statements)

References 31 publications

(39 reference statements)

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“…Our data demonstrate that high baseline NLR (>5.3) is associated with shorter FFLP and OS. A recent study has shown similar trends with a slightly lower cutoff (5) for EHCC cases that were resected with a curative intent, but this did not reach statistical significance . An earlier study has shown a lower NLR cutoff (3) that also predicted survival for both advanced and resected cases of perihilar cholangiocarcinoma …”

Section: Discussionmentioning

confidence: 94%

“…A recent study has shown similar trends with a slightly lower cutoff (5) for EHCC cases that were resected with a curative intent, but this did not reach statistical significance. 24 An earlier study has shown a lower NLR cutoff (3) that also predicted survival for both advanced and resected cases of perihilar cholangiocarcinoma. 25 Our study shows that RT with or without concurrent chemotherapy is well tolerated for the treatment of EHCC.…”

Section: Discussionmentioning

confidence: 95%

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Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma

et al. 2018

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PurposeTo evaluate the effect of escalated dose radiation therapy (EDR, defined as doses >50.4 Gy in 28 fractions [59.5 Gy BED]) on overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) of patients with unresectable extrahepatic cholangiocarcinoma (EHCC).MethodsA consecutive cohort of 80 patients who underwent radiotherapy for unresectable EHCC from 2001 to 2015 was identified. Demographic, tumor, treatment, toxicity, and laboratory variables were collected. The maximal RT doses ranged from 30 to 75 Gy (median 50.4 Gy, at 1.8‐4.5 Gy/fraction). Gross tumor volume (GTV) coverage by maximal dose in EDR group ranged from 38% to 100%. Kaplan–Meier method was used to estimate OS, FFLP, and FFDP. Univariate and multivariate Cox regression models were analyzed.ResultsAfter radiotherapy, median OS, FFLP, and FFDP were 18.7, 22.6, and 24.3 months, respectively. There was no significant difference in OS or FFLP between patients who received EDR to portions of the GTV and patients who did not. On multivariate analysis, bigger GTV, age, and ECOG performance status were independently associated with shorter OS. Local progression on chemotherapy prior to RT was independently associated with shorter FFLP. High baseline neutrophil/lymphocyte ratio (>5.3) was independently associated with shorter FFDP. Toxicity grades were similar in EDR and lower doses except lymphopenia which was higher in EDR (P = 0.053).Conclusions EDR to selective portions of the GTV may not benefit patients with unresectable EHCC despite having acceptable toxicity. New methods to improve local control and survival for unresectable EHCC are needed.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%

Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma

et al. 2018

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“…Severe inflammation is a risk factor for gallbladder perforation 67 . Although increased preoperative inflammation and a high neutrophil-to-lymphocyte ratio are reported as poor prognostic factors in gallbladder cancer 44,68 , this is not reported as part of perforation or risk thereof. Type of surgery (either laparoscopic, converted or open) has no influence on outcome 36 .…”

Section: Intraoperative Events At Primary Surgerymentioning

confidence: 99%

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2018

British Journal of Surgery

101

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Background Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. Methods A systematic PubMed search of the English literature to May 2018 was conducted. Results The search identified 12 systematic reviews and meta‐analyses, in addition to several consensus reports, multi‐institutional series and national audits. Some 0·25–0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one‐third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5‐year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross‐sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET‐avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port‐site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Conclusion Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

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“…Within recent years, new data have been published emphasizing the role of neutrophils and their ability to acquire tumor‐promoting activity, including angiogenesis, mutagenesis, and immunosuppression . More specifically, multiple authors have confirmed that an elevated neutrophil‐to‐lymphocyte ratio (NLR) was shown to be an independent prognostic factor in patients with esophageal, gastric, colon, liver, prostate, and gallbladder cancers …”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio in head and neck cancer prognosis: A systematic review and meta‐analysis

et al. 2018

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Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium

Abstract: Background: Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of

Cited by 47 publications

References 31 publications

Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma

Dose escalation of radiotherapy in unresectable extrahepatic cholangiocarcinoma

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Neutrophil‐to‐lymphocyte ratio in head and neck cancer prognosis: A systematic review and meta‐analysis

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