Preoperative Prognostic Score for Patients with Intrahepatic Cholangiocarcinoma Undergoing Curative-Intent Resection

Area of Science:

• Oncology
• Hepatobiliary Surgery
• Cancer Biomarkers

Background:

• Preoperative inflammatory and nutritional markers like NLR, LMR, PNI, and CONUT have prognostic value in cancers.
• Their comparative predictive utility in intrahepatic cholangiocarcinoma (iCCA) subgroups after curative resection is not well-defined.

Purpose of the Study:

• To evaluate the prognostic significance of preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score.
• To assess their predictive value for recurrence and survival in patients with intrahepatic cholangiocarcinoma (iCCA) undergoing curative-intent resection.

Main Methods:

• Retrospective analysis of 213 iCCA patients who underwent curative resection (2015-2021).
• Calculation of preoperative NLR, LMR, PNI, and CONUT scores from laboratory data.
• Analysis of clinicopathological variables, recurrence, and survival using Cox regression and Kaplan-Meier methods.

Main Results:

• Elevated preoperative NLR (≥ 2.4) independently predicted poorer disease-free survival (DFS) and overall survival (OS).
• This association persisted in patients with R0 resection and those who developed recurrence.
• CONUT score showed correlation with OS in R0 resection and recurrent subgroups; tumor morphology was a significant postoperative factor.

Conclusions:

• Preoperative NLR is a significant predictor of worse DFS and OS in iCCA patients undergoing curative resection.
• The prognostic impact of NLR is consistent across R0 resection and recurrence subgroups.
• CONUT score had limited independent predictive value, primarily in recurrent cases with R0 resection.