Hepatobiliary Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain; Division of Hepatobiliary and Liver Transplantation Surgery. A.O.R.N. Cardarelli, Napoli, Italy.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Eur J Surg Oncol. 2022 Jul;48(7):1576-1584. doi: 10.1016/j.ejso.2022.02.008. Epub 2022 Feb 10.
Distal cholangiocarcinoma (dCC) is still associated with a poor overall survival (OS). This study aims to investigate the impact of novel prognostic scores in comparison with more traditional ones.
Multicentric retrospective analysis of patients who underwent a pancreatoduodenectomy (PD) for dCC. An unadjusted analysis was used to identify predictors of decreased survival. Significant variables were introduced in a multivariable model that assessed OS, recurrence-free survival (RFS), early recurrence (defined as a recurrence within the first 12 months from the PD), local and distant recurrence. Prognostic scores evaluated included the TNM staging system, the lymph-node ratio (LNR), the platelet-lymphocyte ratio (PLR), the neutrophil-lymphocyte ratio (NLR) and the systemic inflammation index (SII).
The study included 232 patients with resected dCC. The optimal cut-off value for LNR was 15% (LNR15). On the unadjusted analysis T stage (p = 0.012), N stage (p < 0.001), LNR15 (p < 0.001), grade (p < 0.001), perineural invasion (p < 0.001) and the R1 status of resection margin (p = 0.001) accounted for the decreased OS. No significant association between survival and PLR, NLR and SII were found. On the multivariable analysis only LNR15, perineural invasion and R1 were independent predictors of decreased RFS (p = 0.003, p = 0.021 and p = 0.009, respectively) and OS (p = 0.001, p = 0.016 and p = 0.013, respectively). Additionally, LNR15 was an independent predictor of early recurrence (p = 0.003) and both LNR15 and R1 were associated with increased local (p < 0.001 and p = 0.010) and distant recurrence (p < 0.001 and p = 0.003).
LNR15 is an independent predictor of DFS, OS, early, local and distal recurrence, combined with the status of the resection margin and perineural invasion.
远端胆管癌（dCC）的总体生存（OS）仍然较差。本研究旨在比较新型预后评分与更传统评分的影响。
对接受胰十二指肠切除术（PD）治疗 dCC 的患者进行多中心回顾性分析。采用未调整分析确定降低生存率的预测因素。将有意义的变量引入多变量模型，评估 OS、无复发生存率（RFS）、早期复发（定义为 PD 后 12 个月内复发）、局部和远处复发。评估的预后评分包括 TNM 分期系统、淋巴结比率（LNR）、血小板-淋巴细胞比率（PLR）、中性粒细胞-淋巴细胞比率（NLR）和全身炎症指数（SII）。
该研究纳入了 232 例接受手术治疗的 dCC 患者。LNR 的最佳截断值为 15%（LNR15）。在未调整的分析中，T 分期（p=0.012）、N 分期（p<0.001）、LNR15（p<0.001）、分级（p<0.001）、神经周围侵犯（p<0.001）和切缘 R1 状态（p=0.001）均与 OS 降低有关。PLR、NLR 和 SII 与生存之间无显著相关性。多变量分析显示，只有 LNR15、神经周围侵犯和 R1 是降低 RFS（p=0.003、p=0.021 和 p=0.009）和 OS（p=0.001、p=0.016 和 p=0.013）的独立预测因素。此外，LNR15 是早期复发的独立预测因素（p=0.003），LNR15 和 R1 与局部（p<0.001 和 p=0.010）和远处（p<0.001 和 p=0.003）复发增加相关。
LNR15 是 DFS、OS、早期、局部和远处复发的独立预测因素，与切缘状态和神经周围侵犯相结合。
