Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1501
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
Processing time: 128 Days and 21.3 Hours
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.
To assess the prognostic value of the gamma-glutamyltransferase to lymphocyte ratio (GLR) in ICC patients following curative resection.
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.
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].
The preoperative GLR is an independent prognostic factor for ICC patients following hepatectomy. A high preoperative GLR is associated with worse OS and RFS.
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.