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
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.
N1 - Funding Information:
Dr Bagante is supported by the International Hepato‐Pancreato‐ Biliary Association (IHPBA), Kenneth Warren Fellowship 2017/2018.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/9/1
Y1 - 2018/9/1
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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U2 - 10.1002/jso.25140
DO - 10.1002/jso.25140
M3 - Article
C2 - 30084163
AN - SCOPUS:85052630440
SN - 0022-4790
VL - 118
SP - 422
EP - 430
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
IS - 3
ER -