Retrospective Study
Copyright ©The Author(s) 2021.
World J Clin Cases. Nov 16, 2021; 9(32): 9770-9782
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9770
Table 1 Patients' demographics
Type of operations
Characteristics
EL (n = 26)
R (n = 210)
P value
Age, yr169 (55-83)70 (25-89)0.57
Sex (male / female)12/14122/880.29
BMI (kg/m2)121.8 (18-31.6)21.8 (15.6-40.1)0.98
Location of the tumor, n
Intrahepatic bile duct (n = 39)633
Perihilar bile duct (n = 55)352
Distal bile duct (n = 55)847
Gallbladder (n = 50)941
Papilla of Vater (n = 37)037
Table 2 Comparison of laboratory findings and inflammation-based prognostic scores
Type of operations
Variables
EL (n = 26)
R (n = 210)
P value
Hb (g/dL)112.0 ± 0.3312.3 ± 0.110.78
Plt (10000/μL)124.4 ± 1.5322.1 ± 0.540.079
PT-INR10.97 ± 0.030.99 ± 0.010.72
Albumin (mg/dL)13.73 ± 0.113.79 ± 0.040.66
ALP (IU/L)1641 ± 98564 ± 340.22
γ-GTP (IU/L)1223 ± 51192 ± 170.28
T-bil (mg/dL)11.74 ± 0.341.24 ± 0.110.083
LDH (IU/L)1212 ± 16187 ± 5.60.079
CRP (mg/dL)10.88 ± 0.931.23 ± 0.330.63
Creatinine clearance (mL/min)1212 ± 16187 ± 5.60.079
Tumor markers
CA19-9 (IU/mL)15198 ± 2767777 ± 3570.014
CEA (ng/mL)112.3 ± 3.15.1 ± 1.00.0054
Inflammation-based prognostic scores
NLR13.92 ± 0.402.81 ± 0.140.0018
PLR1190 ± 18166 ± 6.40.15
PNI143.4 ± 3.446.7 ± 1.20.82
mGPS (A / B, C, D)9 / 17126 / 840.012
Table 3 Cut-off values of each variables determined using receiver operator characteristic curves for all BTC patients
Variables
Cut-off value
Sensitivity
Specificity
PPV
AUC
CA19-9255 IU/mL0.4230.8230.2290.688
CEA7 ng/mL0.3460.9190.3460.645
NLR30.6150.710.2080.667
Table 4 Tumor markers, inflammation-based prognostic scores and survival time according to type of biliary tract cancers
Variables
Type of cancer
IBDCEBDCGBCVater C
(n = 39)(n = 110)(n = 50)(n = 37)
Tumor markers
CA19-9 (IU/mL)17904 ± 33161356 ± 506832 ± 37122 ± 36
CEA (ng/mL) 112.2 ± 26.84.0 ± 7.58.4 ± 22.03.2 ± 3.5
Inflammation-based prognostic scores
NLR13.04 ± 1.602.83 ± 2.203.22 ± 2.272.74 ± 2.04
PLR1151.1 ± 56.9174.0 ± 95.4176.6 ± 99.2163.2 ± 109.9
PNI148.0 ± 5.545.3 ± 24.546.7 ± 7.047.1 ± 7.1
mGPS (A / B, C, D) 10/2947/6332/1810/27
Cumulative survival time (%)2
1-year65.080.182.694.6
3-year48.335.763.275.3
5-year31.326.445.875.3
Table 5 Sensitivity, Specificity and PPV for each biliary cancer
Variables (cut-off value)
Sensitivity
Specificity
PPV
Intrahepatic bile duct cancer
CA19-9 (255 IU/mL)0.8330.6670.313
CEA (7 ng/mL)0.5000.8490.333
NLR (3)0.5000.6360.200
Extrahepatic bile duct cancer
CA19-9 (255 IU/mL)0.2730.7870.125
CEA (7 ng/mL)0.2730.9390.333
NLR (3)0.4550.7270.152
Gallbladder cancer
CA19-9 (255 IU/mL)0.4440.8780.444
CEA (7 ng/mL)0.4440.8780.444
NLR (3)0.8890.6590.364
Table 6 Occult liver and peritoneal metastasis according to each criteria, n (%)
Factor
n of patients
No. of patients with occult liver or peritoneal metastasis
Estimated reduction rate of exploratory laparotomy
CA19-9 > 255 U/mL48 (20)77/48 (14.6)
CEA > 7 ng/mL26 (11)66/26 (23.1)
NLR > 377 (33)1111/77 (14.3)
mGPS = B, C, D101 (43)55/101 (5.0)
Positive factors ≥ 273 (31)1111/73 (15.1)
Positive factors ≥ 326 (11)77/26 (26.9)
Positive factors ≥ 46 (3)22/6 (33.3)