The Comparison of Inflammation-Based Prognostic Scores in Patients With Extrahepatic Bile Duct Cancer After Pancreaticoduodenectomy

Abstract

Background

Inflammation-based prognostic scores are associated with tumor recurrence and survival in various cancers. The aim of this study was to identify the significance of inflammation-based prognostic scores and to detect the most useful score in patients with distal extrahepatic bile duct cancer after pancreaticoduodenectomy.

Methods

Between 2000 and 2015, 121 patients were enrolled in this retrospective study. The relationship between clinicopathological variables including various prognostic scores and disease-free (DFS) as well as overall (OS) survival was investigated by univariate analysis. The area under the receiver operating characteristics curve was calculated to compare the predictive ability of each scoring system. Multivariate analysis was performed to identify the clinicopathological variables associated.

Results

In univariate analysis, Glasgow prognostic score (GPS), mGPS, C-reactive protein/Alb ratio score, prognostic index, and preoperative monocyte count were significant risk factors for both DFS and OS. The area under the receiver operating characteristics curve of GPS is consistently larger in comparison with other four scores in both DFS as well as OS. In multivariate analysis, GPS was an independent risk factor of both tumor recurrence and poor prognosis.

Conclusions

GPS score is an independent tumor recurrence and prognostic factor in patients with distal extrahepatic bile duct cancer and is superior to the other prognostic scores.

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.