Preoperative Glucose-Lymphocyte Ratio: A New Potential Prognostic Marker for Patients with Cholangiocarcinoma

Previous studies demonstrated that diabetes and hyperglycemia promote cholangiocarcinoma (CCA) progression, in vitro and in vivo. However, the predictive abilities of blood glucose levels for CCA prognosis remain unclear. This retrospective cohort analysis included 85 patients with histologically confirmed CCA at Srinagarind Hospital, Khon Kaen University, between 1998 and 2000, comprised 57 males and 28 females with a median age of 56 ± 13 years. The glucose-lymphocyte ratio (GLR) was calculated from preoperative fasting blood glucose and absolute lymphocyte counts, and the cutoff was determined using the receiver operating characteristic curve. Survival analysis revealed that higher GLR was significantly associated with shorter overall survival (P < 0.05). A higher GLR was negatively correlated with total protein, globulin, and lymphocyte counts (P < 0.05). Univariate analysis revealed that a high GLR was associated with male sex and a survival time < 6 months (P < 0.05). The multivariable Cox proportional hazard model showed that a higher GLR was an independent prognostic factor for CCA (adjusted hazard ratio: 1.887; 95% confidence interval: 1.101-3.237), alongside carbohydrate antigen 19-9, staging, neutrophil count, and histological grading. Collectively, these findings indicate that the GLR is a significant prognostic biomarker for CCA, underscoring the importance of metabolic and nutritional status in CCA management.