Ann Hepatobiliary Pancreat Surg.  2023 May;27(2):158-165. 10.14701/ahbps.22-114.

Preoperative neutrophil-to-lymphocyte ratio is prognostic for early recurrence after curative intrahepatic cholangiocarcinoma resection

• Choi WJ
• Perez FM
• Gravely A
• Ivanics T
• Claasen MPAW
• Abraham L
• Abreu P
• Visser R
• Gallinger S
• Hansen BE
• Sapisochin G

• KMID: 2542579
• DOI: http://doi.org/10.14701/ahbps.22-114

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.

Keyword

Cholangiocarcinoma; Hepatectomy; Recurrence; Liver

Figure

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  Fig. 1 Piecewise linear regression model to estimate the cut-off time point for differentiating early versus late recurrence of iCCA. Each line's function was y = 3.52x – 3.45 and y = 0.073x + 44.8, with an intersect at x = 14 months. This cut-off was rounded to 12 months to match those published in the literature.

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