Eliza W Beal1, Lai Wei1, Cecilia G Ethun2, Sylvester M Black1, Mary Dillhoff1, Ahmed Salem3, Sharon M Weber3, Thuy Tran4, George Poultsides4, Andre Y Son4, Ioannis Hatzaras5, Linda Jin6, Ryan C Fields6, Stefan Buettner7, Timothy M Pawlik7, Charles Scoggins8, Robert C G Martin8, Chelsea A Isom9, Kamron Idrees9, Harveshp D Mogal10, Perry Shen10, Shishir K Maithel2, Carl R Schmidt11. 1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. 2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 4. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 5. Department of Surgery, New York University, New York, NY, USA. 6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 7. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. 8. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA. 9. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 11. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. Electronic address: Carl.Schmidt@osumc.edu.
Abstract
BACKGROUND: Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. METHODS: Patients who underwent complete surgical resection between 2000-2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR. RESULTS: Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. CONCLUSIONS: Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.
BACKGROUND: Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. METHODS:Patients who underwent complete surgical resection between 2000-2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR. RESULTS: Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. CONCLUSIONS: Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.
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