Nutritional prognostic scores in patients with hilar cholangiocarcinoma treated by percutaneous transhepatic biliary stenting combined with 125I seed intracavitary irradiation

Abstract

We mainly aimed to preliminarily explore the prognostic values of nutrition-based prognostic scores in patients with advanced hilar cholangiocarcinoma (HCCA).We retrospectively analyzed 73 cases of HCCA, who underwent percutaneous transhepatic biliary stenting (PTBS) combined with I seed intracavitary irradiation from November 2012 to April 2017 in our department. The postoperative changes of total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and albumin (ALB) were observed. The preoperative clinical data were collected to calculate the nutrition-based scores, including controlling nutritional status (CONUT), C-reactive protein/albumin ratio (CAR), and prognostic nutritional index (PNI). Kaplan-Meier curve and Cox regression model were used for overall survival (OS) analyses.The serum levels of TBIL, DBIL, ALT, AST, and ALP significantly reduced, and ALB significantly increased at 1 month and 3 months postoperatively. The median survival time of the cohort was 12 months and the 1-year survival rate was 53.1%. Univariate analysis revealed that the statistically significant factors related to OS were CA19-9, TBIL, ALB, CONUT, and PNI. Multivariate analysis further identified CA19-9, CONUT, and PNI as independent prognostic factors.Nutrition-based prognostic scores, CONUT and PNI in particular, can be used as predictors of survival in unresectable HCCA.

Controlling Nutritional Status (CONUT) Score as a New Indicator of Prognosis in Patients With Hilar Cholangiocarcinoma Is Superior to NLR and PNI: A Single-Center Retrospective Study

“…Derived from total cholesterol, total lymphocyte count and serum albumin, it can assist in the assessment of nutritional status during hospitalization (37,38). In two studies of patients with hilar cholangiocarcinoma after intrahepatic cholangiocarcinoma and adjuvant therapy, a high CONUT score was identified as an independent predictor of poor OS prognosis (19,30). Similar to previous reports, univariate analysis in our study showed that preoperative PNI, NLR, and CONUT were associated with postoperative survival in HCCA patients.…”

“…Among them, the neutrophil lymphocyte ratio (NLR) and prognostic nutritional index (PNI) were considered to be independent prognostic factors that affect the survival of many malignancies (20)(21)(22)(23), and the Controlled Nutritional Status (CONUT) score, as an immune nutritional status scoring system that emerged in 2005, also took serum cholesterol into account when assessing the immune nutritional status of patients compared to PNI and NLR (24,25). The CONUT score, which is comprised of the serum values of albumin (ALB), total lymphocyte count (TLC), and total cholesterol, is considered to be a prognostic factor for postoperative prognosis of malignant tumors such as carcinoma of colon, non-small cell lung cancer, liver cancer and pancreatic ductal adenocarcinoma (26)(27)(28)(29), and has also been reported to be an important prognostic factor for survival in nonresectable HCCA (30).…”

Recent Changes and Improvements in Multidisciplinary Perioperative Management From a Nutritional Perspective: Dental Specialty Should Be Considered Important

“…In 1984, Onodera et al [26] have proposed that the linear predictive model relating the risk of operative complication and/or mortality to nutritional status is given by the relationship: PNI = 10 × serum albumin level (Alb) (g/dl) + 0.005 × total lymphocytes count (TLC)/mm3 in peripheral blood. PNI is simple to calculate, easy to interpret, and has been widely used to assess the preoperative immunologic and nutritional status of patients undergoing digestive surgery [27][28][29]. Our finding suggested that poor dental occlusal support might cause immunological and nutritional problems, leading to higher surgical risk and lower survival.…”

Biliary stenting alone versus biliary stenting combined with 125I particles intracavitary irradiation for the treatment of advanced cholangiocarcinoma

“…About one week later, PTBS with or without 125 I particles implantation were performed under digital subtraction angiography. The process has been described previously 14,15 . The dose delivered by 125 I particles implantation was approximately at 1 cm from the center of the radioactive source.…”