The impact of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio among patients with intrahepatic cholangiocarcinoma

S Buettner, G Spolverato, CW Kimbrough, S Alexandrescu, HP Marques, J Lamelas, L Aldrighetti, TC Gamblin, SK Maithel, C Pulitano, M Weiss, TW Bauer, F Shen, GA Poultsides, JW Marsh, JNM IJzermans, BG Koerkamp, TM Pawlik

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Abstract

Background: Neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio may be host factors associated with prognosis. We sought to determine whether neutrophil-to-lymphocyte and platelets-to-lymphocyte ratio were associated with overall survival among patients undergoing surgery for intrahepatic cholangiocarcinoma. Methods: Patients who underwent resection for intrahepatic cholangiocarcinoma between 1990 and 2015 were identified from 12 major centers. Clinicopathologic factors and overall survival were compared among patients stratified by neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio. Risk factors identified on multivariable analysis were included in a prognostic model and the discrimination was assessed using Harrell's concordance index (C index). Results: A total of 991 patients were identified. Median neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio were 2.7 (interquartile range [IQR]: 2.0–4.0) and 109.6 (IQR: 72.4–158.8), respectively. Preoperative neutrophil-to-lymphocyte ratio was elevated (≥5) in 100 patients (10.0%) and preoperative platelets-to-lymphocyte ratio (≥190) in 94 patients (15.2%). Patients with low and high neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio generally had similar baseline characteristics with regard to tumor characteristics. Overall survival was 37.7 months (95% confidence interval [CI]: 32.7–42.6); 1-, 3-, and 5-year overall survival was 78.8%, 51.6%, and 39.3%, respectively. Patients with an neutrophil-to-lymphocyte ratio .05). On multivariable analysis, an elevated neutrophil-to-lymphocyte ratio was independently associated with decreased overall survival (hazard ratio: 1.04, 95% CI: 1.01–1.07; P =.002). Patients could be stratified into low- versus high-risk groups based on standard tumor-specific factors such as lymph node status, tumor size, number, and vascular invasion (C index 0.62). When neutrophil-to-lymphocyte ratio was added to the prognostic model, the discriminatory ability of the model improved (C index 0.71). Conclusion: Elevated neutrophil-to-lymphocyte ratio was independently associated with worse overall survival and improved the prognostic estimation of long-term survival among patients with intrahepatic cholangiocarcinoma undergoing resection. © 2018 Elsevier Inc.
Original languageEnglish
Pages (from-to)411-418
JournalSurgery
Volume164
Issue number3
DOIs
Publication statusPublished - 2018

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Buettner, S., Spolverato, G., Kimbrough, CW., Alexandrescu, S., Marques, HP., Lamelas, J., Aldrighetti, L., Gamblin, TC., Maithel, SK., Pulitano, C., Weiss, M., Bauer, TW., Shen, F., Poultsides, GA., Marsh, JW., IJzermans, JNM., Koerkamp, BG., & Pawlik, TM. (2018). The impact of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio among patients with intrahepatic cholangiocarcinoma. Surgery, 164(3), 411-418. https://doi.org/10.1016/j.surg.2018.05.002