Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2020; 26(13): 1501-1512
Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1501
Preoperative gamma-glutamyltransferase to lymphocyte ratio predicts long-term outcomes in intrahepatic cholangiocarcinoma patients following hepatic resection
Jin-Ju Wang, Hui Li, Jia-Xin Li, Lin Xu, Hong Wu, Yong Zeng
Jin-Ju Wang, Hui Li, Jia-Xin Li, Hong Wu, Yong Zeng, Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Lin Xu, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610065, Sichuan Province, China
Author contributions: Wang JJ, Hui Li and Jia-Xin Li contributed equally to this work; Wang JJ, Wu H and Zeng Y designed the research; Li H and Xu L collected the data; Wang JJ and Li JX analyzed the data and wrote the paper.
Supported by the National Key Technologies RD Program, No. 2018YFC1106803; the Natural Science Foundation of China, No. 81972747, No. 81872004, No. 81770615 and No. 81672882; the Science and Technology Support Program of Sichuan Province, No. 2019YFQ0001 and No. 2017SZ0003.
Institutional review board statement: This work was reviewed and approved by the Ethics Committee of the West China Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Zeng, MD, PhD, Professor, Doctor, Surgeon, Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China. zengyong@medmail.com.cn
Received: November 30, 2019
Peer-review started: November 30, 2019
First decision: January 16, 2020
Revised: February 17, 2020
Accepted: March 5, 2020
Article in press: March 5, 2020
Published online: April 7, 2020
Abstract
BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) is a heterogeneous hepatobiliary cancer with limited treatment options. A number of studies have illuminated the relationship between inflammation-based prognostic scores and outcomes in patients with ICC. However, the use of reliable and personalized prognostic algorithms in ICC after resection is pending.

AIM

To assess the prognostic value of the gamma-glutamyltransferase to lymphocyte ratio (GLR) in ICC patients following curative resection.

METHODS

ICC patients following curative resection (2009-2017) were divided into two cohorts: The derivation cohort and validation cohort. The derivation cohort was used to explore an optimal cut-off value, and the validation cohort was used to further evaluate the score. Overall survival (OS) and recurrence-free survival (RFS) were analyzed, and predictors of OS and RFS were determined.

RESULTS

A total of 527 ICC patients were included and randomly divided into the derivation cohort (264 patients) and the validation cohort (263 patients). The two patient cohorts had comparable baseline characteristics. The optimal cut-off value for the GLR was 33.7. Kaplan-Meier curves showed worse OS and RFS in the GLR > 33.7 group compared with GLR ≤ 33.7 group in both cohorts. After univariate and multivariate analysis, the results indicated that GLR was an independent prognostic factor of OS [derivation cohort: hazard ratio (HR) = 1.620, 95% confidence interval (CI): 1.066-2.462, P = 0.024; validation cohort: HR = 1.466, 95%CI: 1.033-2.142, P = 0.048] and RFS [derivation cohort: HR = 1.471, 95%CI: 1.029-2.103, P = 0.034; validation cohort: HR = 1.480, 95%CI: 1.057-2.070, P = 0.022].

CONCLUSION

The preoperative GLR is an independent prognostic factor for ICC patients following hepatectomy. A high preoperative GLR is associated with worse OS and RFS.

Keywords: Gamma-glutamyltransferase, Lymphocyte ratio, Gamma-glutamyltransferase to lymphocyte ratio, Intrahepatic cholangiocarcinoma, Prognosis, Survival analysis

Core tip: This study investigated the clinical significance of preoperative gamma-glutamyltransferase to lymphocyte ratio (GLR) levels in intrahepatic cholangiocarcinoma (ICC) patients following hepatectomy. We retrospectively enrolled 527 ICC patients underwent curative hepatectomy at our center. The results showed that a higher GLR is associated with worse overall survival and recurrence-free survival in ICC patients after hepatectomy. Thus, the preoperative GLR is an independent prognostic factor for ICC patients following curative resection.