Unveiling the prognostic role of blood inflammatory indexes in a retrospective cohort of patients undergoing liver resection for intrahepatic cholangiocarcinoma

Flavio Milana ^1,2, Michela A Polidoro ³, Cristiana Soldani ³

⁰Department of Biomedical Sciences, Humanitas University.

International Journal of Surgery (london, England) +

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July 5, 2024

View abstract on PubMed

Summary

Blood inflammatory indexes like neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) can predict intrahepatic cholangiocarcinoma (iCCA) survival. These markers correlate with the tumor microenvironment, aiding patient stratification for targeted therapies.

Area Of Science

Oncology
Immunology
Biomarkers

Background

Systemic inflammation plays a role in intrahepatic cholangiocarcinoma (iCCA).
Prognostic value of inflammatory indexes and their link to the tumor microenvironment in iCCA remain controversial.
This study investigates the biological and prognostic significance of inflammatory indexes in iCCA.

Purpose Of The Study

To evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in intrahepatic cholangiocarcinoma (iCCA).
To explore the correlation between these blood inflammatory indexes and the iCCA tumor microenvironment.
To identify potential patient subgroups for tailored treatment strategies.

Main Methods

Retrospective cohort study of 101 iCCA patients undergoing hepatic resection (2010-2021).
Analysis of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and clinic-pathological factors.
Flow cytometry for immune-cell subpopulations in surgical specimens; X-Tile software for cut-off determination; survival analyses (Kaplan-Meier, Cox regression).

Main Results

NLR ≥3.83 and LMR <2.28 were associated with worse survival.
Two risk groups identified: low-risk (66.3%) and high-risk (33.7%), with significantly different 5-year overall survival rates (49.8% vs. 18.9%).
High-risk group with elevated CA19-9 showed increased mortality and recurrence risk. NLR correlated with tumor-derived NLR, and LMR with tumor-infiltrating lymphocytes. High-risk group had more CD4+ T-cells, while low-risk group had more CD8+ T-cells.

Conclusions

Combined blood inflammatory indexes (NLR, LMR) define distinct survival-risk profiles in iCCA patients.
A link exists between peripheral inflammatory markers and the tumor immune microenvironment, including T-cell infiltration.
These findings support patient stratification for personalized follow-up and targeted immunochemotherapy protocols.