Prediction Efficacy of Prognostic Nutritional Index and Albumin–Bilirubin Grade in Patients With Intrahepatic Cholangiocarcinoma After Radical Resection: A Multi-Institutional Analysis of 535 Patients

Abstract

BackgroundThe preoperative nutritional status and the immunological status have been reported to be independent prognostic factors of patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to investigate whether prognostic nutritional index (PNI) + albumin–bilirubin (ALBI) could be a better predictor than PNI and ALBI alone in patients with ICC after radical resection.MethodsThe prognostic prediction evaluation of the PNI, ALBI, and the PNI+ALBI grade was performed in 373 patients with ICC who underwent radical resection between 2010 and 2018 at six Chinese tertiary hospitals, and external validation was conducted in 162 patients at four other Chinese tertiary hospitals. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan–Meier method. Multivariate analysis was conducted to identify independent prognostic factors. A time-dependent receiver operating characteristic (ROC) curve and a nomogram prediction model were further constructed to assess the predictive ability of PNI, ALBI, and the PNI+ALBI grade. The C-index and a calibration plot were used to assess the performance of the nomogram models.ResultsUnivariate analysis showed that PNI, ALBI, and the PNI+ALBI grade were prognostic factors for the OS and RFS of patients with ICC after radical resection in the training and testing sets (p < 0.001). Multivariate analysis showed that the PNI+ALBI grade was an independent risk factor for OS and RFS in the training and testing sets (p < 0.001). Analysis of the relationship between the PNI+ALBI grade and clinicopathological characteristics showed that the PNI+ALBI grade correlated with obstructive jaundice, alpha-fetoprotein (AFP), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), PNI, ALBI, Child–Pugh grade, type of resection, tumor size, major vascular invasion, microvascular invasion, T stage, and N stage (p < 0.05). The time-dependent ROC curves showed that the PNI+ALBI grade had better prognostic predictive ability than the PNI, ALBI, and the Child–Pugh grade in the training and testing sets.ConclusionPreoperative PNI+ALBI grade is an effective and practical predictor for the OS and RFS of patients with ICC after radical resection.

Preoperative Assessment of Skeletal Muscle Mass and Muscle Quality Using Computed Tomography: Incidence of Sarcopenia in Patients with Intrahepatic Cholangiocarcinoma Selected for Liver Resection

“…Some authors investigated the role of prognostic nutritional markers with sarcopenia. Li and colleagues [ 4 ] explored the prognostic value of the preoperative albumin–globulin score with the skeletal muscle index as well as their combination in patients with ICC treated with surgical resection. This combination was related to the postoperative long-term outcomes of surgically treated ICC patients.…”

“…This combination was related to the postoperative long-term outcomes of surgically treated ICC patients. The authors concluded that their index, which can be preoperatively used, could represent a useful tool for risk classification and for clinical therapeutic decision-making for ICC patients [ 4 ]. A similar experience was reported by Yu [ 10 ], who showed that patients with high fibrinogen–albumin ratios and incidence of sarcopenia, had shorter overall survival and recurrence-free survival than other patients.…”

“…Elevated levels of carbohydrate antigen 19.9 (Ca-19.9), a poorly differentiated tumor, or microvascular invasion represent well-known prognostic factors for the survival of these patients. The prognostic nutritional index and inflammatory levels have been reported to be independent prognostic factors of patients with ICC [ 4 ].…”

Clinical Value of Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio in Prediction of the Development of Sepsis-Induced Kidney Injury

“…PNI was developed to assess the preoperative nutritional immune status and postoperative complications in surgical patients and has since been demonstrated to be a reliable prognostic factor for numerous malignancies, such as gastric cancer [ 16 ], intrahepatic cholangiocarcinoma [ 29 ], esophageal cancer [ 30 ], and nasopharyngeal carcinoma [ 31 ]. In the field of sepsis, Wu et al reported that after adjusting for confounding variables, PNI was asserted to be an independent prognostic factor for all-cause mortality at 30 days [ 32 ].…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…For example, ALBI has been shown to be prognostic in cancers other than HCC, including pancreatic, colon and gastric cancer, intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, and even brain cancer (glioma and medulloblastoma). [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] , [136] ALBI is likely to be reflective of liver dysfunction in patients undergoing hepatic resection for intrahepatic tumours, such as intrahepatic cholangiocarcinoma or metastatic liver tumours, and tolerance for those undergoing systemic therapy, including chemotherapies, molecular-targeted drugs and immune checkpoint inhibitors. 118 , 123 , [126] , [127] , [128] , 131 , 133 , 134 Although most authors have attempted to link the association of ALBI with a particular cancer to liver function, we should consider whether its association with mortality is actually through some aspect of liver dysfunction or whether it simply reflects the prognostic power of serum albumin and bilirubin levels, independent of liver function.…”