Department of Digestive Surgery, Tochigi Cancer Center, Utsunomiya, Japan,
Department of Digestive Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
Oncology. 2019;96(6):290-298. doi: 10.1159/000499050. Epub 2019 Mar 25.
Several preoperative systemic inflammatory parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and Glasgow Prognostic Score, have been reported to be associated with the prognosis of solid tumors. However, there are conflicting survival data regarding these parameters in cholangiocarcinoma.
In this study, we performed a retrospective cohort analysis of patients with distal cholangiocarcinoma (DCC) who underwent surgical resection to evaluate the prognostic value of a cluster of preoperative hematological inflammatory parameters for survival.
Fifty-three patients with DCC who underwent pancreaticoduodenectomy with curative intent were enrolled. The optimal cutoff values of hematological inflammatory parameters, including the absolute lym-phocyte count, NLR, PLR, and LMR, were determined by time-dependent receiver operating characteristic analysis. -Results: The univariate analysis for overall survival (OS) of conventional factors and hematological inflammatory parameters identified that portal vein invasion and PLR had p values of ≤0.1. The univariate analysis for disease-free survival (DFS) identified that lymph node metastasis, PLR, lymphocyte count, and number of positive lymph nodes (≥3) had p values of ≤0.1. These factors were incorporated into the full model and variables were selected using the backward stepwise method. The multivariate analysis identified portal vein invasion and high PLR as independent prognostic factors for OS (p = 0.033 and 0.039, respectively) and high PLR and number of positive lymph nodes (≥3) as independent prognostic factors for DFS (p = 0.016 and 0.004, respectively).
Preoperative PLR assessment may be useful for detecting high-risk DCC patients undergoing surgical resection for aggressive adjuvant therapy.
几项术前系统性炎症参数，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）和格拉斯哥预后评分，已被报道与实体瘤的预后相关。然而，这些参数在胆管癌中的生存数据存在矛盾。
本研究对接受胰十二指肠切除术的远端胆管癌（DCC）患者进行回顾性队列分析，以评估一组术前血液学炎症参数对生存的预后价值。
纳入 53 例接受胰十二指肠切除术的 DCC 患者，手术目的为治愈。通过时间依赖性接收器工作特征分析确定血液学炎症参数（包括绝对淋巴细胞计数、NLR、PLR 和 LMR）的最佳截断值。
对总生存（OS）的常规因素和血液学炎症参数的单因素分析确定门静脉侵犯和 PLR 的 p 值均≤0.1。无病生存（DFS）的单因素分析确定淋巴结转移、PLR、淋巴细胞计数和阳性淋巴结数量（≥3）的 p 值均≤0.1。这些因素被纳入全模型，并使用后向逐步法选择变量。多因素分析确定门静脉侵犯和高 PLR 是 OS 的独立预后因素（p=0.033 和 0.039），高 PLR 和阳性淋巴结数量（≥3）是 DFS 的独立预后因素（p=0.016 和 0.004）。
术前 PLR 评估可能有助于检测接受手术切除的高危 DCC 患者，以便进行积极的辅助治疗。
