Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics and Clinicopathological Data
3.2. Prognostic Factors of Resected Biliary Tract Cancer Patients
3.3. Recurrence-Free Survival and Overall Survival
4. Discussion
Strengths and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient Numbers | Percentage (%) | |
---|---|---|
Gender | ||
Male | 167 | 58.2 |
Female | 120 | 41.8 |
Age (Median: 61.5± 10.93 years old) | ||
<62 | 136 | 47.4 |
≧62 | 151 | 52.6 |
Performance status (ECOG) | ||
0 | 175 | 61.0 |
1 | 78 | 27.2 |
2 | 34 | 11.8 |
Tumor site | ||
Intrahepatic | 177 | 61.7 |
Gall bladder | 37 | 12.9 |
Common bile duct | 51 | 17.8 |
Perihilar | 22 | 7.7 |
Tumor size | ||
T1 | 81 | 28.2 |
T2 | 111 | 38.7 |
T3 | 51 | 17.8 |
T4 | 44 | 15.3 |
Lymph nodes | ||
N0 | 102 | 35.5 |
N1 | 47 | 16.4 |
N2 | 3 | 1 |
No dissection | 135 | 47.0 |
TMN stage | ||
I | 83 | 28.9 |
II | 124 | 43.2 |
III | 39 | 13.6 |
IV | 41 | 14.3 |
Hepatitis B | ||
Yes | 99 | 34.5 |
No | 188 | 65.5 |
Hepatitis C | ||
Yes | 48 | 16.7 |
No | 239 | 83.3 |
CA199 before surgery | ||
<350 | 227 | 79.1 |
≧350 | 60 | 20.9 |
Vascular invasion | ||
No | 133 | 46.3 |
Yes | 134 | 46.7 |
Portal invasion | 20 | 7.0 |
Surgical margin | ||
R0 | 217 | 75.6 |
R1 | 37 | 12.9 |
Close margin (1 mm) | 33 | 11.5 |
Adjuvant treatment | ||
No | 214 | 74.6 |
Chemotherapy | 53 | 18.5 |
CCRT | 13 | 4.5 |
Radiotherapy | 7 | 2.4 |
ERCC1 | ||
Negative | 247 | 86.1 |
Positive | 40 | 13.9 |
XRCC1 | ||
Negative | 251 | 87.5 |
Positive | 36 | 12.5 |
Albumin | ||
<3.5 | 88 | 30.7 |
≧3.5 | 199 | 69.3 |
NLR | ||
<2.28 | 119 | 41.5 |
≧2.28 | 166 | 58.5 |
Clinical and Pathological Characteristics | Albumin | NLR | ANS | |||||||
---|---|---|---|---|---|---|---|---|---|---|
<3.5 | ≧3.5 | p-Value | <2.28 | ≧2.28 | p-Value | 0 | 1 | 2 | p-Value | |
N = 88 | N = 199 | N = 119 | N = 168 | N = 96 | N = 126 | N = 65 | ||||
Age | ||||||||||
<62 | 39 | 97 | 0.489 | 63 | 73 | 0.113 | 52 | 56 | 28 | 0.260 |
≧62 | 49 | 102 | 56 | 95 | 44 | 70 | 37 | |||
Sex | ||||||||||
Male | 52 | 115 | 0.837 | 69 | 98 | 0.953 | 56 | 72 | 39 | 0.930 |
Female | 36 | 84 | 50 | 70 | 40 | 54 | 26 | |||
Tumor location | ||||||||||
Intrahepatic | 46 | 131 | 0.132 | 85 | 92 | 0.012 | 70 | 76 | 31 | 0.037 |
Gall bladder | 12 | 25 | 15 | 22 | 12 | 16 | 9 | |||
Common bile duct | 21 | 30 | 14 | 37 | 10 | 24 | 17 | |||
Hilar | 9 | 13 | 5 | 17 | 4 | 10 | 8 | |||
p-T Status | ||||||||||
1–2 | 46 | 146 | 0.001 | 99 | 93 | 0.001 | 83 | 79 | 30 | 0.001 |
3–4 | 42 | 53 | 20 | 75 | 13 | 47 | 35 | |||
p-N status | ||||||||||
Negative | 29 | 73 | 0.001 | 37 | 65 | 0.001 | 32 | 46 | 24 | 0.001 |
Positive | 26 | 24 | 12 | 38 | 7 | 22 | 21 | |||
No dissection | 33 | 102 | 70 | 65 | 57 | 58 | 20 | |||
AJCC pathological stage | ||||||||||
I-II | 53 | 154 | 0.003 | 98 | 109 | 0.001 | 82 | 88 | 37 | 0.001 |
III-IV | 35 | 45 | 21 | 59 | 14 | 38 | 28 | |||
Vascular invasion | ||||||||||
No | 29 | 104 | 0.002 | 62 | 71 | 0.100 | 55 | 56 | 22 | 0.012 |
Yes | 59 | 95 | 57 | 97 | 41 | 70 | 43 | |||
Surgical margin | ||||||||||
R0 | 55 | 162 | 0.003 | 99 | 118 | 0.033 | 81 | 99 | 37 | 0.002 |
Close margin (1 mm) | 16 | 17 | 8 | 25 | 7 | 11 | 15 | |||
R1 | 17 | 20 | 12 | 25 | 8 | 16 | 13 | |||
DM. | ||||||||||
No | 64 | 143 | 0.88 | 94 | 113 | 0.029 | 76 | 85 | 46 | 0.150 |
Yes | 24 | 56 | 25 | 55 | 20 | 41 | 19 | |||
HBV | ||||||||||
No | 68 | 120 | 0.005 | 63 | 125 | 0.001 | 50 | 83 | 55 | 0.001 |
Yes | 20 | 79 | 56 | 43 | 46 | 43 | 10 | |||
HCV | ||||||||||
No | 76 | 163 | 0.351 | 92 | 147 | 0.023 | 75 | 105 | 59 | 0.108 |
Yes | 12 | 36 | 27 | 21 | 21 | 21 | 6 | |||
CA19-9 | ||||||||||
<350 | 58 | 169 | 0.001 | 104 | 123 | 0.004 | 87 | 99 | 41 | 0.001 |
≧350 | 30 | 30 | 15 | 45 | 9 | 27 | 24 | |||
Performance status (ECOG) | ||||||||||
0 | 40 | 135 | 0.002 | 83 | 92 | 0.026 | 73 | 72 | 30 | 0.001 |
1 | 33 | 45 | 23 | 55 | 13 | 42 | 23 | |||
2 | 15 | 19 | 13 | 21 | 10 | 12 | 12 | |||
Recurrence | ||||||||||
Yes | 60 | 81 | 0.001 | 49 | 92 | 0.023 | 33 | 64 | 44 | 0.001 |
No | 28 | 118 | 70 | 76 | 63 | 62 | 21 | |||
ERCC1 | ||||||||||
Negative | 81 | 166 | 0.064 | 98 | 149 | 0.166 | 77 | 110 | 60 | 0.078 |
Positive | 7 | 33 | 21 | 19 | 19 | 16 | 5 | |||
XRCC1 | ||||||||||
Negative | 78 | 173 | 0.835 | 100 | 151 | 0.196 | 80 | 133 | 58 | 0.339 |
Positive | 10 | 26 | 19 | 17 | 16 | 13 | 7 |
Variables | Category | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|---|
HR. | 95% CI | p-Value | HR. | 95% CI | p-Value | ||
Age | <62 vs. ≧62 | 0.937 | 0.67–1.31 | 0.699 | 0.762 | 0.53–1.09 | 0.141 |
Gender | Female vs. male | 0.772 | 0.55–1.09 | 0.139 | 0.762 | 0.86–1.81 | 0.245 |
ECOG performance | 0 | Reference | |||||
1 | 1.56 | 1.08–2.28 | 0.020 | 1.159 | 0.78–1.73 | 0.473 | |
2 | 2.198 | 1.37–3.54 | 0.001 | 1.409 | 0.85–2.34 | 0.183 | |
Tumor location | Intrahepatic | Reference | |||||
Gall bladder | 0.728 | 0.41–1.31 | 0.288 | 0.541 | 0.29–1.02 | 0.057 | |
Common bile duct | 1.40 | 0.92–2.13 | 0.114 | 1.285 | 0.75–2.20 | 0.359 | |
Hilar | 1.52 | 0.86–2.68 | 0.148 | 0.476 | 0.25–0.92 | 0.026 | |
p-T status | 3–4 vs. 1–2 | 2.42 | 1.73–3.38 | <0.001 | |||
p-N status | Negative | Reference | |||||
Positive | 2.35 | 1.54–3.61 | <0.001 | ||||
No lymph node dissection | 1.089 | 0.74–1.61 | 0.667 | ||||
AJCC pathological stage | III–IV vs. I–II | 2.525 | 1.80–3.55 | <0.001 | 2.285 | 1.47–3.55 | <0.001 |
Vascular invasion | Yes vs. No | 2.048 | 1.45–2.90 | <0.001 | 1.998 | 1.37–2.92 | <0.001 |
Surgical margin | R0 | Reference | |||||
Margin 1 mm | 1.424 | 0.86–2.36 | 0.169 | 1.104 | 0.65–1.87 | 0.715 | |
R1 | 2.443 | 1.57–3.81 | <0.001 | 1.510 | 0.92–2.47 | 0.101 | |
Adjuvant Treatment | Yes vs. No | 1.46 | 1.03–2.08 | 0.035 | 0.630 | 0.41–0.96 | 0.032 |
DM | Yes vs. No | 0.902 | 0.62–1.30 | 0.580 | 0.853 | 0.58–1.26 | 0.426 |
HBV | Yes vs. No | 0.620 | 0.43–0.90 | 0.011 | 0.669 | 0.44–1.03 | 0.067 |
HCV | Yes vs. No | 0.819 | 0.52–1.30 | 0.399 | 1.121 | 0.68–1.85 | 0.654 |
CA19-9 | ≧350 vs. <350 | 3.373 | 2.36–4.82 | <0.001 | 3.271 | 2.17–4.93 | <0.001 |
ERCC1 | Positive vs. negative | 1.244 | 0.74–2.09 | 0.412 | 0.837 | 0.51–1.38 | 0.484 |
XRCC1 | Positive vs. negative | 1.16 | 0.71–1.90 | 0.566 | 1.27 | 0.75–2.15 | 0.372 |
Albumin | ≧3.5 vs. <3.5 | 0.386 | 0.28–0.54 | <0.001 | |||
NLR | <2.28 vs.≧2.28 | 1.615 | 1.14–2.29 | 0.007 | |||
ANS | 2 | Reference | |||||
0 | 0.290 | 0.18–0.46 | <0.001 | 0.497 | 0.30–0.82 | 0.007 | |
1 | 0.494 | 0.34–0.73 | <0.001 | 0.638 | 0.42–0.96 | 0.031 |
Variates | Category | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|---|
HR | 95% CI | p-Value | HR | 95% CI | p-Value | ||
Age | <62 vs. ≧62 | 0.761 | 0.53–1.09 | 0.134 | 1.005 | 0.69–1.47 | 0.980 |
Gender | Female vs. male | 0.904 | 0.63–1.30 | 0.587 | 1.071 | 0.72–1.59 | 0.732 |
ECOG performance | 0 | Reference | |||||
1 | 2.151 | 1.45–3.19 | <0.001 | 1.502 | 0.98–2.30 | 0.062 | |
2 | 2.714 | 1.64–4.49 | <0.001 | 1.623 | 0.94–2.79 | 0.080 | |
Tumor location | Intrahepatic | Reference | |||||
Gall bladder | 0.968 | 0.52–1.79 | 0.866 | 0.541 | 0.45–1.66 | 0.665 | |
Common bile duct | 1.640 | 1.06–2.53 | 0.026 | 1.466 | 0.84–2.57 | 0.183 | |
Hilar | 1.928 | 1.06–3.50 | 0.031 | 0.819 | 0.42–1.61 | 0.561 | |
p-T status | 3–4 vs. 1–2 | 2.551 | 1.79–3.65 | <0.001 | |||
p-N status | Negative | Reference | |||||
Positive | 2.686 | 1.63–4.29 | <0.001 | ||||
No lymph node dissection | 1.126 | 0.74–1.73 | 0.586 | ||||
AJCC pathological stage | III–IV vs. I–II | 2.441 | 1.70–3.51 | <0.001 | 2.140 | 1.36–3.38 | 0.001 |
Vascular invasion | Yes vs. no | 2.303 | 1.57–3.37 | <0.001 | 1.998 | 1.33–3.01 | 0.001 |
Surgical margin | R0 | Reference | |||||
Margin 1 mm | 1.591 | 0.93–2.73 | 0.092 | 1.148 | 0.63–2.03 | 0.635 | |
R1 | 3.623 | 2.37–5.55 | <0.001 | 2.240 | 1.40–3.57 | 0.001 | |
Adjuvant Treatments | Yes vs. No | 1.419 | 0.97–2.07 | 0.070 | 0.622 | 0.40–0.97 | 0.034 |
DM | Yes vs. No | 1.436 | 0.99–2.09 | 0.060 | 1.106 | 0.74–1.65 | 0.624 |
HBV | Yes vs. No | 0.516 | 0.34–0.78 | 0.002 | 0.675 | 0.42–1.08 | 0.103 |
HCV | Yes vs. No | 0.760 | 0.46–1.27 | 0.294 | 1.017 | 0.59–1.76 | 0.951 |
CA19-9 | ≧350 vs. <350 | 2.875 | 1.98–4.19 | <0.001 | 2.333 | 1.54–3.54 | <0.001 |
ERCC1 | Positive vs. negative | 0.972 | 0.58–1.62 | 0.913 | 0.861 | 0.51–1.45 | 0.573 |
XRCC1 | Positive vs. negative | 0.74 | 0.45–1.22 | 0.24 | 0.652 | 0.39–1.08 | 0.097 |
Albumin | <3.5 vs. ≧3.5 | 0.385 | 0.27–0.55 | <0.001 | |||
NLR | ≧2.28 vs. <2.28 | 1.751 | 1.20–2.56 | 0.004 | |||
ANS | 2 | Reference | |||||
0 | 0.261 | 0.16–0.43 | <0.001 | 0.532 | 0.31–0.93 | 0.027 | |
1 | 0.482 | 0.32–0.73 | <0.001 | 0.626 | 0.41–0.97 | 0.034 |
Recurrent Free Survival | Overall Survival | |||
---|---|---|---|---|
Variates | Area under the ROC Curve (95% CI) | p-Value | Area under the ROC Curve (95% CI) | p-Value |
ANC | 0.627 (0.563–0.691) | <0.001 | 0.636 (0.571–0.0700) | <0.001 |
Albumin | 0.612 (0.547–0.677) | 0.001 | 0.611 (0.544–0.678) | 0.001 |
NLR | 0.536 (0.497–0.629) | 0.065 | 0.575 (0.509–0.642) | 0.029 |
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Chiu, T.-J.; Liu, Y.-W.; Yong, C.-C.; Yin, S.-M.; Yeh, C.-H.; Chen, Y.-Y. Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection. Cancers 2023, 15, 5474. https://doi.org/10.3390/cancers15225474
Chiu T-J, Liu Y-W, Yong C-C, Yin S-M, Yeh C-H, Chen Y-Y. Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection. Cancers. 2023; 15(22):5474. https://doi.org/10.3390/cancers15225474
Chicago/Turabian StyleChiu, Tai-Jan, Yueh-Wei Liu, Chee-Chien Yong, Shih-Min Yin, Cheng-His Yeh, and Yen-Yang Chen. 2023. "Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection" Cancers 15, no. 22: 5474. https://doi.org/10.3390/cancers15225474