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
ARTICLE HIGHLIGHTS
Research background

Intrahepatic cholangiocarcinoma (ICC) is a heterogeneous hepatobiliary cancer with limited treatment options and has a high mortality. Therefore, it is important to probe effective biomarkers or prognostic models for ICC patients following hepatic resection at risk of recurrence or metastasis. Accumulating studies has found that a system inflammatory response is important in tumor progression and recurrence. However, it is not yet clear whether neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) or gamma-glutamyltransferase to lymphocyte ratio (GLR), can be used as a novel prognostic factor for ICC patients following hepatic resection.

Research motivation

Timely and effective establishment of prognostic models for ICC patients following curative resection is of great value for the long-term outcomes of these patients.

Research objectives

The main aim of our study was to examine the role of inflammation markers in ICC patients and evaluate the prognostic value of GLR in ICC patients following curative resection.

Research methods

We retrospectively enrolled ICC patients following curative resection between January 2009 and September 2017 at the West China Hospital of Sichuan University. The ICC patients were divided into a derivation cohort and a 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.

Research results

In all, 527 ICC patients were included and divided into the derivation cohort (264 patients) and the validation cohort (263 patients). The two cohorts had comparable baseline characteristics. The optimal cut-off values for the NLR, PLR and GLR were 2.62, 103 and 33.7, respectively. The overall survival (OS) and recurrence-free survival (RFS) were shorter in the GLR > 33.7 group than GLR ≤ 33.7 group in both derivation cohort and validation cohort. Multivariate analysis revealed that the GLR was an independent predictor 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 = 0.048; validation cohort: HR = 1.480, 95%CI: 1.057-2.070, P = 0.022). Besides, CA19-9 also be demonstrated as an independent predictor of OS and RFS in both cohorts (all P < 0.05). However, our results showed that NLR and PLR were not independent predictors of OS or RFS in ICC patients in our center.

Research conclusions

The OS and RFS of ICC patients following curative resection are shorter in the GLR > 33.7 group than GLR ≤ 33.7 group. The preoperative GLR is an independent prognostic factor for ICC patients following hepatectomy. A high preoperative GLR is associated with worse OS and RFS.

Research perspectives

Because our study used a single-center retrospective design and enrolled limited patients. Future studies which included more centers and patients are needed to further verify our results.