Novel prognostic score based on the preoperative total bilirubin-albumin ratio and fibrinogen-albumin ratio in ampullary adenocarcinoma

Table 1 Comparing the baseline characteristics of different score groups in ampullary adenocarcinoma

Variables	Total (n = 188)	Score-0 (n = 88)	Score-1 (n = 84)	Score-2 (n = 16)	P value
Gender, n (%)					0.166
Male	112 (59.574)	58 (65.909)	47 (55.952)	7 (43.750)
Female	76 (40.426)	30 (34.091)	37 (44.048)	9 (56.250)
Age, median (IQR)	58 (50, 64)	58 (51, 64)	59 (50, 66)	53 (45, 64)	0.449
Differentiation, n (%)					0.052
Poor	73 (38.830)	34 (38.636)	36 (42.857)	3 (18.750)
Moderate	70 (37.234)	38 (43.182)	27 (32.143)	5 (31.250)
Well	45 (23.936)	16 (18.182)	21 (25.000)	8 (50.000)
Tumor size, n (%)					0.479
≤ 2 cm	94 (50.000)	43 (48.864)	45 (53.571)	6 (37.500)
> 2 cm	94 (50.000)	45 (51.136)	39 (46.429)	10 (62.500)
AST (U/L), median (IQR)	57 (35, 112)	72 (48, 126)	50 (23, 94)	30 (20, 72)	< 0.001
ALT (U/L), median (IQR)	87 (36, 150)	105 (66, 186)	54 (29, 117)	45 (18, 70)	< 0.001
CEA (ng/mL), median (IQR)	2.75 (1.88, 3.81)	3.06 (1.85, 4.48)	2.58 (1.92, 3.78)	2.24 (1.94, 2.97)	0.193
CA199 (U/mL), median (IQR)	55.80 (18.83, 184.30)	60.84 (27.41, 162.30)	55.80 (13.57, 191.40)	35.46 (20.32, 72.94)	0.444
Perioperative transfusion, n (%)					0.226
No	96 (51.064)	45 (51.136)	46 (54.762)	5 (31.250)
Yes	92 (48.936)	43 (48.864)	38 (45.238)	11 (68.750)
T stage, n (%)					0.088
I	36 (19.149)	10 (11.364)	21 (25.000)	5 (31.250)
II	57 (30.319)	28 (31.818)	23 (27.381)	6 (37.500)
III	95 (50.532)	50 (56.818)	40 (47.619)	5 (31.250)
Examined lymph nodes, median (IQR)	11 (7, 18)	12 (8, 18)	11 (6, 19)	9 (4, 10)	0.044
Examined lymph node, n (%)					0.035
< 12	107 (56.915)	47 (53.409)	46 (54.762)	14 (87.500)
≥ 12	81 (43.085)	41 (46.591)	38 (45.238)	2 (12.500)
Lymph node metastasis, n (%)					0.402
No	140 (74.468)	63 (71.591)	63 (75.000)	14 (87.500)
Yes	48 (25.532)	25 (28.409)	21 (25.000)	2 (12.500)
TNM stage, n (%)					None
I	82 (43.617)	32 (36.364)	40 (47.619)	10 (62.500)
II	76 (40.426)	37 (42.045)	33 (39.286)	6 (37.500)
III	30 (15.957)	19 (21.591)	11 (13.095)	0 (0.000)
Vessel invasion, n (%)					None
No	141 (75.000)	57 (64.773)	68 (80.952)	16 (100.000)
Yes	47 (25.000)	31 (35.227)	16 (19.048)	0 (0.000)
Postoperative complications, n (%)					0.353
No	110 (58.511)	49 (55.682)	49 (58.333)	12 (75.000)
Yes	78 (41.489)	39 (44.318)	35 (41.667)	4 (25.000)
Adjuvant treatment, n (%)					0.235
No	134 (71.277)	59 (67.045)	61 (72.619)	14 (87.500)
Yes	54 (28.723)	29 (32.955)	23 (27.381)	2 (12.500)
Fibrinogen (g/L), median (IQR)	3.68 (3.12, 4.22)	3.71 (3.20, 4.02)	3.74 (3.15, 4.42)	3.06 (2.67, 3.96)	0.153
Albumin (g/L), median (IQR)	37.10 (31.40, 41.20)	39.00 (35.40, 41.40)	35.70 (27.60, 41.70)	4.13 (3.82, 4.47)	< 0.001
Total bilirubin (μmol/L), median (IQR)	38.70 (12.82, 173.60)	161.90 (63.10, 228.80)	15.31 (8.96, 24.58)	1.32 (0.75, 1.99)	< 0.001
FAR, median (IQR)	0.106 (0.086, 0.150)	0.095 (0.086, 0.109)	0.134 (0.084, 0.195)	0.687 (0.174, 0.764)	< 0.001
TBAR, median (IQR)	0.538 (0.205, 2.325)	0.266 (0.162, 0.580)	1.807 (0.386, 3.303)	3.694 (2.742, 5.027)	< 0.001

IQR: Interquartile range; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199; TNM: Tumor-node-metastasis; FAR: Fibrinogen-albumin ratio; TBAR: Total bilirubin-albumin ratio.

Table 2 Univariate and multivariate logistic analysis of independent factors predicting the tumor recurrence

Variables	Univariable analysis			Multivariable analysis
	OR	95%CI	P value	OR	95%CI	P value
Gender
Male		Reference
Female	1.176	0.656-2.110	0.586
Age
< 60		Reference
≥ 60	0.747	0.414-1.347	0.332
Differentiation
Poor		Reference
Moderate	1.150	0.596-2.216	0.677
Well	0.599	0.279-1.286	0.189
Tumor size
≤ 2 cm		Reference
> 2 cm	0.879	0.496-1.561	0.661
Perioperative transfusion
No		Reference
Yes	0.619	0.347-1.103	0.104
Operation time
≤ 3 h
> 3 h and ≤ 6 h
> 6 h
T stage
I		Reference			Reference
II	1.197	0.506-2.833	0.683	0.815	0.321-2.064	0.665
III	2.051	0.930-4.521	0.075	0.743	0.132-4.184	0.736
Examined lymph nodes
< 12		Reference
≥ 12	1.359	0.761-2.427	0.300
Lymph node metastasis
No		Reference			Reference
Yes	2.735	1.384-5.406	0.004	1.224	0.425-3.524	0.707
TNM stage
I		Reference			Reference
II	1.560	0.823-2.956	0.173	1.574	0.289-8.574	0.600
III	6.005	2.300-15.676	< 0.001	4.149	0.491-35.043	0.191
Vessel invasion
No		Reference			Reference
Yes	2.601	1.313-5.151	0.006	1.353	0.616-2.970	0.451
Postoperative complications
No		Reference
Yes	0.696	0.387-1.250	0.225
Adjuvant treatment
No		Reference
Yes	1.689	0.893-3.192	0.107
CEA	1.071	0.978-1.172	0.139
CA199	1.000	1.000-1.000	0.824
TBAR	0.988	0.895-1.090	0.807
FAR	0.504	0.182-1.393	0.186
Score
0		Reference			Reference
1	0.469	0.255-0.863	0.015	0.517	0.270-0.988	0.046
2	0.167	0.045-0.630	0.008	0.236	0.060-0.922	0.038

CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199; TNM: Tumor-node-metastasis; FAR: Fibrinogen-albumin ratio; TBAR: Total bilirubin-albumin ratio; OR: Odds ratio; CI: Confidence interval.

Table 3 Univariable and multivariable Cox regression analysis of overall survival time in ampullary adenocarcinoma

Variables	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
Gender
Male		Reference
Female	1.080	0.711-1.639	0.719
Age
< 60		Reference
≥ 60	1.198	0.788-1.822	0.398
Differentiation
Poor		Reference			Reference
Moderate	0.873	0.548-1.391	0.568	0.981	0.600-10603	0.938
Well	0.596	0.344-1.034	0.066	0.979	0.501-1.911	0.949
Tumor size
≤ 2 cm		Reference
> 2 cm	1.139	0.756-1.716	0.534
Perioperative transfusion
No		Reference
Yes	0.861	0.570-1.298	0.474
T stage
I		Reference			Reference
II	0.927	0.485-1.769	0.817	0.792	0.375-1.672	0.541
III	2.128	1.211-3.741	0.009	1.731	0.474-6.322	0.407
Examined lymph nodes
< 12		Reference
≥ 12	1.344	0.881-2.051	0.171
Lymph node metastasis
No		Reference			Reference
Yes	2.203	1.407-3.447	0.001	1.704	0.851-3.412	0.132
TNM stage
I		Reference			Reference
II	1.965	1.230-3.137	0.005	0.886	0.272-2.888	0.841
III	3.030	1.711-5.368	< 0.001	0.918	0.208-4.057	0.910
Vessel invasion
No		Reference
Yes	1.410	0.885-2.248	0.148
Postoperative complications
No		Reference
Yes	1.343	0.886-2.035	0.164
Adjuvant treatment
No		Reference
Yes	0.946	0.590-1.514	0.816
CEA	1.001	0.999-1.004	0.359
CA199	1.000	1.000-1.000	0.585
TBAR	0.966	0.880-1.061	0.470
FAR	0.748	0.359-1.558	0.438
Score
0		Reference			Reference
1	0.787	0.518-1.196	0.262	0.890	0.577-1.373	0.599
2	0.176	0.043-0.726	0.016	0.230	0.054-0.972	0.046

CEA: Carcinoembryonic antigen; CA199: Carbohydrate antigen 199; TNM: Tumor-node-metastasis; FAR: Fibrinogen-albumin ratio; TBAR: Total bilirubin-albumin ratio; HR: Hazard ratio; CI: Confidence interval.