Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection

Özgür Akgül, Fabio Bagante, Griffin Olsen, Jordan M. Cloyd, Matthew J Weiss, Katiuscha Merath, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Olivier Soubrane, Guillaume Martel, B. Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. Methods: Patients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI ≥ 40 and <40 were compared using univariable and multivariable analyses. Results: Among 637 patients, 53 patients had PNI < 40 (8.3%) and 584 patients had PNI ≥ 40 (91.7%). While there was no difference between PNI groups with regard to tumor size (P =.87), patients with PNI < 40 were more likely to have multifocal disease (PNI < 40, n = 16, 30.2% vs PNI ≥ 40, n = 65, 11.1%; P < 0.001), poorly differentiated or undifferentiated ICC (PNI < 40, n = 13, 25.5% vs PNI ≥ 40, n = 75, 13.1%; P = 0.020) and T2/T3/T4 disease vs patients with PNI ≥ 40 (PNI < 40, n = 38, 71.7% vs PNI ≥ 40, n = 265, 45.4%; P < 0.001). Patients with PNI ≥ 40 had better OS vs patients with PNI < 40 (5-year OS: PNI ≥ 40: 47.5%, 95% CI, 42.2 to 52.6% vs PNI < 40: 24.6%, 95% CI, 12.1 to 39.6%; P < 0.001). On multivariable analysis, PNI < 40 remained associated with increase risk of death (HR, 1.71; 95% CI, 1.15 to 2.53; P = 0.008). Conclusion: A low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Nutrition Assessment
Cholangiocarcinoma
Survival

Keywords

  • intrahepatic cholangiocarcinoma
  • lymphocytes
  • nutritional index
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection. / Akgül, Özgür; Bagante, Fabio; Olsen, Griffin; Cloyd, Jordan M.; Weiss, Matthew J; Merath, Katiuscha; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Soubrane, Olivier; Martel, Guillaume; Koerkamp, B. Groot; Guglielmi, Alfredo; Itaru, Endo; Pawlik, Timothy M.

In: Journal of Surgical Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Akgül, Ö, Bagante, F, Olsen, G, Cloyd, JM, Weiss, MJ, Merath, K, Alexandrescu, S, Marques, HP, Aldrighetti, L, Maithel, SK, Pulitano, C, Bauer, TW, Shen, F, Poultsides, GA, Soubrane, O, Martel, G, Koerkamp, BG, Guglielmi, A, Itaru, E & Pawlik, TM 2018, 'Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection', Journal of Surgical Oncology. https://doi.org/10.1002/jso.25140
Akgül, Özgür ; Bagante, Fabio ; Olsen, Griffin ; Cloyd, Jordan M. ; Weiss, Matthew J ; Merath, Katiuscha ; Alexandrescu, Sorin ; Marques, Hugo P. ; Aldrighetti, Luca ; Maithel, Shishir K. ; Pulitano, Carlo ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Soubrane, Olivier ; Martel, Guillaume ; Koerkamp, B. Groot ; Guglielmi, Alfredo ; Itaru, Endo ; Pawlik, Timothy M. / Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection. In: Journal of Surgical Oncology. 2018.
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title = "Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection",
abstract = "Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. Methods: Patients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI ≥ 40 and <40 were compared using univariable and multivariable analyses. Results: Among 637 patients, 53 patients had PNI < 40 (8.3{\%}) and 584 patients had PNI ≥ 40 (91.7{\%}). While there was no difference between PNI groups with regard to tumor size (P =.87), patients with PNI < 40 were more likely to have multifocal disease (PNI < 40, n = 16, 30.2{\%} vs PNI ≥ 40, n = 65, 11.1{\%}; P < 0.001), poorly differentiated or undifferentiated ICC (PNI < 40, n = 13, 25.5{\%} vs PNI ≥ 40, n = 75, 13.1{\%}; P = 0.020) and T2/T3/T4 disease vs patients with PNI ≥ 40 (PNI < 40, n = 38, 71.7{\%} vs PNI ≥ 40, n = 265, 45.4{\%}; P < 0.001). Patients with PNI ≥ 40 had better OS vs patients with PNI < 40 (5-year OS: PNI ≥ 40: 47.5{\%}, 95{\%} CI, 42.2 to 52.6{\%} vs PNI < 40: 24.6{\%}, 95{\%} CI, 12.1 to 39.6{\%}; P < 0.001). On multivariable analysis, PNI < 40 remained associated with increase risk of death (HR, 1.71; 95{\%} CI, 1.15 to 2.53; P = 0.008). Conclusion: A low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.",
keywords = "intrahepatic cholangiocarcinoma, lymphocytes, nutritional index, surgery",
author = "{\"O}zg{\"u}r Akg{\"u}l and Fabio Bagante and Griffin Olsen and Cloyd, {Jordan M.} and Weiss, {Matthew J} and Katiuscha Merath and Sorin Alexandrescu and Marques, {Hugo P.} and Luca Aldrighetti and Maithel, {Shishir K.} and Carlo Pulitano and Bauer, {Todd W.} and Feng Shen and Poultsides, {George A.} and Olivier Soubrane and Guillaume Martel and Koerkamp, {B. Groot} and Alfredo Guglielmi and Endo Itaru and Pawlik, {Timothy M.}",
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TY - JOUR

T1 - Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection

AU - Akgül, Özgür

AU - Bagante, Fabio

AU - Olsen, Griffin

AU - Cloyd, Jordan M.

AU - Weiss, Matthew J

AU - Merath, Katiuscha

AU - Alexandrescu, Sorin

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Maithel, Shishir K.

AU - Pulitano, Carlo

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Soubrane, Olivier

AU - Martel, Guillaume

AU - Koerkamp, B. Groot

AU - Guglielmi, Alfredo

AU - Itaru, Endo

AU - Pawlik, Timothy M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. Methods: Patients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI ≥ 40 and <40 were compared using univariable and multivariable analyses. Results: Among 637 patients, 53 patients had PNI < 40 (8.3%) and 584 patients had PNI ≥ 40 (91.7%). While there was no difference between PNI groups with regard to tumor size (P =.87), patients with PNI < 40 were more likely to have multifocal disease (PNI < 40, n = 16, 30.2% vs PNI ≥ 40, n = 65, 11.1%; P < 0.001), poorly differentiated or undifferentiated ICC (PNI < 40, n = 13, 25.5% vs PNI ≥ 40, n = 75, 13.1%; P = 0.020) and T2/T3/T4 disease vs patients with PNI ≥ 40 (PNI < 40, n = 38, 71.7% vs PNI ≥ 40, n = 265, 45.4%; P < 0.001). Patients with PNI ≥ 40 had better OS vs patients with PNI < 40 (5-year OS: PNI ≥ 40: 47.5%, 95% CI, 42.2 to 52.6% vs PNI < 40: 24.6%, 95% CI, 12.1 to 39.6%; P < 0.001). On multivariable analysis, PNI < 40 remained associated with increase risk of death (HR, 1.71; 95% CI, 1.15 to 2.53; P = 0.008). Conclusion: A low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.

AB - Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. Methods: Patients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI ≥ 40 and <40 were compared using univariable and multivariable analyses. Results: Among 637 patients, 53 patients had PNI < 40 (8.3%) and 584 patients had PNI ≥ 40 (91.7%). While there was no difference between PNI groups with regard to tumor size (P =.87), patients with PNI < 40 were more likely to have multifocal disease (PNI < 40, n = 16, 30.2% vs PNI ≥ 40, n = 65, 11.1%; P < 0.001), poorly differentiated or undifferentiated ICC (PNI < 40, n = 13, 25.5% vs PNI ≥ 40, n = 75, 13.1%; P = 0.020) and T2/T3/T4 disease vs patients with PNI ≥ 40 (PNI < 40, n = 38, 71.7% vs PNI ≥ 40, n = 265, 45.4%; P < 0.001). Patients with PNI ≥ 40 had better OS vs patients with PNI < 40 (5-year OS: PNI ≥ 40: 47.5%, 95% CI, 42.2 to 52.6% vs PNI < 40: 24.6%, 95% CI, 12.1 to 39.6%; P < 0.001). On multivariable analysis, PNI < 40 remained associated with increase risk of death (HR, 1.71; 95% CI, 1.15 to 2.53; P = 0.008). Conclusion: A low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.

KW - intrahepatic cholangiocarcinoma

KW - lymphocytes

KW - nutritional index

KW - surgery

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DO - 10.1002/jso.25140

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