Tsilimigras DI, Mehta R, Aldrighetti L, et al. - Given the challenges encountered in estimating prognosis in the preoperative setting as most survival risk scores depend solely on postoperative factors, researchers sought to generate a composite score that incorporated preoperative liver, tumor, nutritional and inflammatory markers for predicting long-term outcomes following resection of intrahepatic cholangiocarcinoma (ICC). An international multi-institutional database yielded data from 660 patients who underwent curative-intent hepatectomy for ICC between 2000-2017. Median and 5-year overall survival (OS) were 43.2 months and 42.4%, respectively. The multivariable analysis revealed OS to be correlated with following laboratory values: carbohydrate antigen 19-9 (HR = 1.16), neutrophil-to-lymphocyte ratio (HR = 1.09), platelet count (HR = 1.01) and albumin (HR = 0.75). They observed an incrementally worse 5-year OS of 54.9%, 38.2% and 21.6% among patients with a LabScore of 0-9 (n = 223), 10-19 (n = 353) and > 20 (n = 88), respectively. In both the test (c-index: 0.70) and validation cohorts, the model performed well (c-index: 0.67); further, it outperformed individual laboratory markers, the prognostic nutritional index (c-index: 0.58) and 8th edition AJCC staging (c-index: 0.60). Findings thus suggest the LabScore as possibly valuable for preoperatively identifying patients who will benefit the most from upfront surgery or alternative treatment options including neoadjuvant chemotherapy prior to resection.