Buettner S, et al. - Whether or not neutrophil-to-lymphocyte and platelets-to-lymphocyte ratio were associated with overall survival among patients undergoing surgery for intrahepatic cholangiocarcinoma is assessed. Findings suggested an independent association of elevated neutrophil-to-lymphocyte ratio with worse overall survival and improved the prognostic estimation of long-term survival among these patients.

Methods

• From 12 major centers, researchers identified patients who underwent resection for intrahepatic cholangiocarcinoma between 1990 and 2015.
• Patients stratified by neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio were compared regarding clinicopathologic factors and overall survival.
• They included risk factors identified on multivariable analysis in a prognostic model and assessed the discrimination using Harrell's concordance index (C index).

Results

• Researchers identified 991 patients.
• Median neutrophil-to-lymphocyte ratio was 2.7 (interquartile range [IQR]: 2.0–4.0) and median platelets-to-lymphocyte ratio was 109.6 (IQR: 72.4–158.8).
• They noted that 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%).
• Generally similar baseline characteristics with regard to tumor characteristics were noted among patients with low and high neutrophil-to-lymphocyte ratio and platelets-to-lymphocyte ratio.
• Overall survival of 37.7 months was observed(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 <5 showed a median survival of 47.1 months (95% CI: 37.9–53.3) vs 21.9 months (95% CI: 4.8–39.1) noted among patients with an neutrophil-to-lymphocyte ratio ≥5 (P=.001).
• In contrast, comparable long-term survival was observed among patients who had a platelets-to-lymphocyte ratio <190 vs platelets-to-lymphocyte ratio ≥190 had (P > .05).
• On multivariable analysis, an independent association of an elevated neutrophil-to-lymphocyte ratio was noted with decreased overall survival (hazard ratio: 1.04, 95% CI: 1.01–1.07; P=.002).
• Based on standard tumor-specific factors such as lymph node status, tumor size, number, and vascular invasion (C index 0.62), patients could be stratified into low- vs high-risk groups.
• On addition of neutrophil-to-lymphocyte ratio to the prognostic model, improvement in the discriminatory ability of the model was noted (C index 0.71).