GastrointestinalThe Comparison of Inflammation-Based Prognostic Scores in Patients With Extrahepatic Bile Duct Cancer After Pancreaticoduodenectomy
Introduction
Distal extrahepatic bile duct cancer consists of cholangiocarcinoma of bile duct and ampulla of Vater cancer. For patients with distal extrahepatic bile duct cancer, pancteaticoduodenectomy with lymph node dissection is the only curative and recommended treatment for patients with distal extrahepatic bile duct cancer. Despite recent improvements in perioperative surgical techniques, the 5-y survival rate after curative resection in patients with cholangiocarcinoma of the bile duct and cancer of the ampulla are still less than 50% because of high rapid progression and early recurrence of the tumor.1, 2, 3, 4 Therefore, to detect useful prognostic factors and to identify a risk group for tumor recurrence is important for postoperative management after surgical resection.
Recently, it has been reported that the outcomes of patients with cancer were determined not only by tumor-related factors but also by host-related factors. The systemic inflammation-based prognostic factors have been detected in operable or inoperable patients with various types of malignancy. These factors can be divided into two groups. Glasgow prognostic score (GPS),5, 6, 7 modified GPS, and C-reactive protein (CRP) to albumin ratio (CRP/Alb ratio)8, 9 are scoring based on CRP. On the other hand, neutrophil to lymphocyte ratio (NLR)10 and platelet to lymphocyte ratio (PLR)11 are scoring based on the cellular components. In spite of many publications related to inflammation-based prognostic factors in various type of cancer, little is reported in inflammation-based prognostic factors in patients with operable or inoperable bile duct cancer.12, 13
The aim of the present study was to investigate the relationship between the inflammation-based prognostic factors and disease-free survival (DFS) as well as overall survival (OS) and to identify a more useful prognostic factor compared with other various inflammation-based prognostic factors in patients with extrahepatic bile duct cancer after pancreaticoduodenectomy.
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Patients
Between July 2000 and December 2015, a total of 127 patients with distal extrahepatic bile duct cancer including cholangioadenocarcinoma or carcinoma of the ampulla of Vater underwent pancreaticoduodenectomy at the Department of Surgery, The Jikei University Hospital, Tokyo, Japan. Of these, six patients were excluded, two lost to follow-up and four due to lack of perioperative information, leaving the remaining 121 patients for this study. Postoperative patients were followed carefully as an
Results
Univariate analysis of clinicopathological variables in relation to DFS as well as OS in patients with distal extrahepatic bile duct cancer after pancreaticoduodenectomy.
Table 2 lists univariate analysis of the relationship between the clinicopathologic variables and DFS as well as OS after pancreaticoduodenectomy. In univariate analysis of DFS, ≥ 70 y of age (P = 0.021), cholangioadenocarcinoma (P = 0.001), preoperative biliary drainage (P < 0.001), ≥ 800 mL of intraoperative blood loss (P
Discussion
Antitumor immune response plays an important role in tumor progression and prognosis. The presence of tumor-infiltrating CD8-positive lymphocytes has been reported as a predictor of survival in patients with bile duct cancer.15 On the other hand, the host immune response against cancers contributes to develop and progress cancer because of induction of the inflammation around the tumor tissue.16 As a result, cancer-induced inflammation promotes proliferation of the tumor cells, tumor
Conclusion
GPS score, an inflammation-based prognostic score, is an independent surrogate marker of tumor recurrence and survival in patients with distal extrahepatic bile duct cancer after pancreaticoduodenectomy, which seems to be superior to the other inflammation-based prognostic scores.
Acknowledgment
Authors’ contributions: Y.F. designed the study, collected and analyzed the data, wrote the article; H.S. reviewed the article; R.H., Y.S., K.H., K.F. were collected the data and helped to analysis. T.G. helped to write article. Y.K. reviewed the article.
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Ethics approval: This study was approved by the Ethics Committee of the Jikei University School of Medicine (Approved number; 21-121).