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Prognostic Value of Perioperative Inflammatory-Immune-Nutritional Indicators in Advanced Gallbladder Cancer
Rongxuan Li1, Bingchen Wang1, Xiao Chen1
1Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Objective:
To explore the perioperative changes in inflammatory-immune-nutritional indicators in patients with advanced gallbladder cancer (GBC), defined as American Joint Committee on Cancer (AJCC) Stage III-IV, and to assess whether individual indicators provide incremental prognostic information beyond conventional clinicopathological factors.
Methods:
Patients with pathologically confirmed advanced GBC who underwent surgery at the Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, between 2010 and 2022 were retrospectively enrolled. Preoperative and postoperative Day 7 values of the albumin-to-alkaline phosphatase ratio (AAPR), albumin-to-globulin ratio (AGR), albumin-bilirubin score (ALBI), advanced lung cancer inflammation index (ALI), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and systemic inflammation response index (SIRI) were calculated. Perioperative dynamic changes were compared, and Cox proportional hazards models were constructed to evaluate the incremental prognostic value of these indicators.
Results:
Among 103 patients with advanced GBC, all eight inflammatory-immune-nutritional indicators showed significant changes between the preoperative period and postoperative Day 7. Several preoperative and postoperative indicators were associated with cancer-specific survival (CSS) in cutoff-based exploratory analyses. After the incorporation of these indicators into clinicopathological models, most extended models showed varying degrees of improvement in discrimination and goodness of fit.
Conclusion:
In this single-center cohort, perioperative inflammatory-immune-nutritional indicators exhibit significant dynamic changes in advanced GBC and can improve, to a certain extent, the prognostic performance of models based on conventional clinicopathological characteristics. These indicators may serve as useful supplementary tools for risk stratification and individualized prognostic assessment in patients with advanced GBC.
