Özgür Akgül1, Fabio Bagante1,2, Griffin Olsen1, Jordan M Cloyd1, Matthew Weiss3, Katiuscha Merath1, Sorin Alexandrescu4, Hugo P Marques5, Luca Aldrighetti6, Shishir K Maithel7, Carlo Pulitano8, Todd W Bauer9, Feng Shen10, George A Poultsides11, Olivier Soubrane12, Guillaume Martel13, B Groot Koerkamp14, Alfredo Guglielmi2, Endo Itaru15, Timothy M Pawlik1. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 2. Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland. 4. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 5. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 6. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 7. Department of Surgery, Emory University, Atlanta, Georgia. 8. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 9. Department of Surgery, University of Virginia, Charlottesville, Virginia. 10. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 11. Department of Surgery, Stanford University, Stanford, California. 12. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon, Hospital, Clichy, France. 13. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. 14. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 15. Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan.
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.
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.
Authors: Amika Moro; Rittal Mehta; Kota Sahara; Diamantis I Tsilimigras; Anghela Z Paredes; Ayesha Farooq; J Madison Hyer; Itaru Endo; Feng Shen; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Olivier Soubrane; Bas G Koerkamp; Kazunari Sasaki; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2020-03-20 Impact factor: 5.344