Prognostic utility of preoperative inflammatory markers in patients with intrahepatic cholangiocarcinoma after hepatic resection: A systematic review and meta‐analysis

Abstract

Background The prognostic value of preoperative systemic inflammatory markers, including the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and lymphocyte‐to‐monocyte ratio (LMR), remains controversial in patients with intrahepatic cholangiocarcinoma (ICC). Therefore, this meta‐analysis aimed to investigate the prognostic value of preoperative NLR, PLR, and LMR in patients with ICC who underwent hepatic resection. Methods We conducted a comprehensive search of four electronic databases. Two researchers assessed the quality of the available data using the Newcastle–Ottawa Scale. We selected overall survival (OS) as the primary outcome and recurrence‐free survival (RFS) and disease‐free survival (DFS) as secondary outcomes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were merged to evaluate the associations between inflammatory markers and ICC patient prognosis. Results Fifteen studies (18 cohorts) with 4123 cases were included in this meta‐analysis. The results revealed that a high preoperative NLR was associated with short OS and RFS (HR = 1.04, 95% CI: 1.01–1.07, and HR = 1.29, 95% CI: 1.04–1.60, respectively) in patients with ICC. However, the association between PLR or LMR and ICC prognosis was not statistically significant. In addition, the publication bias and sensitivity analyses demonstrated that the results were reliable and stable. Conclusion Our meta‐analysis revealed that preoperative NLR may be a useful prognostic predictor for patients with ICC.

Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma

“…Jia’s study showed that a high preoperative level of serum prealbumin could be a poor prognostic factor for HCC ( 35 ). Elevated NLR, FAR, FPR, PLR, and MLR levels were related to the poor prognosis of patients with a variety of malignant tumors, including colorectal cancer (CRC) ( 36 ), GC ( 7 ), PC ( 8 ), ICC ( 10 ), and HCC ( 37 ). Fan’s study showed that a higher FLR was significantly related to poor OS and DFS for ESCC ( 38 ).…”

“…For example, high levels of fibrinogen, fibrinogen-to-prealbumin ratio (FPR), neutrophil-to-lymphocyte ratio (NLR), and fibrinogen-to-albumin ratio (FAR) could predict poor prognosis in patients with esophageal squamous cell carcinoma (ESCC) ( 6 ), resectable gastric cancer (GC) ( 7 ), metastatic pancreatic cancer (PC) ( 8 ), and triple-negative breast cancer (TNBC) ( 9 ). High NLR, platelet-to-lymphocyte ratio (PLR), and FAR values and low lymphocyte-to-monocyte ratio (LMR) values could be prognostic factors for short overall survival (OS) in patients with CCA ( 10 – 12 ). There have been some studies on ICC ( 13 – 16 ); however, very few studies have referred to ECC, PCC ( 11 ), and DCC ( 17 , 18 ).…”

Biomarkers for predicting the prognosis of intrahepatic cholangiocarcinoma: A retrospective single-center study

“…Preoperative and postoperative nutritional and inflammatory indicators in patients with ICC have gradually attracted the attention of scientists as well as clinicians. [ 4 ] These indicators include prognostic nutrition index (PNI), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio, albumin-bilirubin fraction, aspartate aminotransferase (AST) to neutrophil ratio index (ANRI), albumin-to-alkaline phosphatase ratio (AAPR), albumin to gamma-glutamyltransferase ratio (AGR), platelet to albumin ratio (PAR), body mass index (BMI), and prothrombin time (PT). [ 5 ] In this study, we explored the relationship between the above indicators and patient prognosis after surgery for ICC.…”

“…[3] Preoperative and postoperative nutritional and inflammatory indicators in patients with ICC have gradually attracted the attention of scientists as well as clinicians. [4] These indicators include prognostic nutrition index (PNI), neutrophil to XL, ZS, XL, and QW contributed equally to this work.…”

Preoperative Serum Markers and Risk Classification in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study

“…Many indices of nutrition, immunity, and inflammatory status have been found to be appropriate prognostic factors for various carcinomas [ 14 , 15 , 16 , 17 , 18 , 19 ]. These indices are based on preoperative findings and include the neutrophil-to-lymphocyte ratio (NLR) [ 20 ], prognostic nutritional index (PNI) [ 21 ], platelet-to-lymphocyte ratio (PLR) [ 22 ], C-reactive protein (CRP)-to-albumin ratio (CAR) [ 23 ], and CRP-albumin-lymphocyte (CALLY) index [ 24 ]. Given the likelihood of these inflammatory indicators to be prognostic for reduced overall survival (OS) and recurrence-free survival (RFS), pretreatment inflammatory indicators may serve as useful biomarkers for poor prognosis in patients with cholangiocarcinoma.…”