Surgical treatment of intrahepatic cholangiocarcinoma: outcomes and predictive factors

Ellis, Michelle C.; Cassera, Maria A.; Vetto, John T.; Orloff, Susan L.; Hansen, Paul; Billingsley, Kevin G.

doi:10.1111/j.1477-2574.2010.00242.x

Cited by 30 publications

(24 citation statements)

References 14 publications

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“…Albumin is a widely used indicator of nutrition and has been shown to correlate with post-operative complications (Fujiwara et al , 2010; Ellis et al , 2011; Lai et al , 2011). However there is increasing evidence that the presence of cancer cachexia, partly reflected by a reduction in albumin, is driven by a sustained inflammatory response, either from the tumour itself or as a host reaction (Esper and Harb, 2005).…”

Section: Discussionmentioning

confidence: 99%

A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)

2012

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Background:There is increasing evidence that the presence of an ongoing systemic inflammatory response is a stage-independent predictor of poor outcome in patients with cancer. The aim of this study was to investigate whether an inflammation-based prognostic score, the prognostic nutritional index (PNI), is associated with overall survival (OS) in patients with hepatocellular carcinoma (HCC).Methods:All patients with a new diagnosis of HCC presenting to the Medical Oncology Department, Hammersmith Hospital between 1993 and 2011 (n=112) were included. Demographic and clinical data were collected. Patients in whom the combined albumin (g l−1) × total lymphocyte count × 109 l−1 was ⩾45, at presentation, were allocated a PNI score of 0. Patients in whom this total score was <45 were allocated a score of 1. Univariate and multivariate analyses were performed to identify clinicopathological variables associated with OS. Independent predictors of survival identified on multivariate analysis were validated in an independent, stage-matched cohort of 68 patients.Results:Univariate analyses showed that PNI (P=0.003), intrahepatic spread (P<0.001), the presence of extrahepatic disease (P=0.006), portal vein thrombosis (P=0.02), tumour multifocality (P=0.003), alfa-fetoprotein >400 ng ml−1 (P<0.001) and Barcelona Clinic Liver Cancer score (P<0.01) were all predictors of OS in the training set. Multivariate analysis revealed the PNI (P=0.05), presence of extrahepatic disease (P<0.001) and degree of intrahepatic spread (P<0.001) as independent predictors of worse OS in this population. The PNI retained independent prognostic value in the validation set (P<0.001).Conclusion:The presence of a systemic inflammatory response, as measured by the PNI, is an independent and externally validated predictor of poor OS in patients with HCC.

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Section: Discussionmentioning

confidence: 99%

A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)

2012

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“…Albumin is a widely used parameter of nutrition and has been shown to correlate with postoperative complications [13,14]. In addition, low serum albumin has been reported to be an independent predictor of long-term outcomes in several malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Preoperative Prognostic Nutritional Index in Epithelial Ovarian Cancer Patients Treated with Platinum-Based Chemotherapy

Miao

Yan

et al. 2016

Oncol Res Treat

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Background: The aim of present study was to investigate the role of the prognostic nutritional index (PNI) used as a prognostic marker for predicting response and survival outcomes in patients with epithelial ovarian cancer (EOC) who are receiving platinum-based chemotherapy. Patients and Methods: Patients with a new diagnosis of EOC receiving postoperative platinum-based chemotherapy were identified. The PNI was calculated as 10 × serum albumin value (g/dl) + 0.005 × peripheral lymphocyte count (per mm³). Patients were divided into a platinum-resistant (P-R) group and a platinum-sensitive (P-S) group according to the chemotherapeutic response. A receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off value for PNI to predict chemotherapeutic response and prognosis. Results: A total of 344 patients were enrolled. Area under the curve, sensitivity, and specificity of PIN < 45 to predict platinum resistance were: 0.688, 62.50%, and 83.47%, respectively. Patients with a lower PNI (< 45) had shorter progression-free survival (PFS) and overall survival (OS). PNI showed a significant association with PFS (hazard ratio (HR) 1.890, 95% confidence interval (CI) 1.396-2.560; p < 0.001) and OS (HR 1.747, 95% CI 1.293-2.360; p < 0.001). Conclusion: Our results suggest that PNI assessment could assist the identification of patients with a poor prognosis and has potential clinical value in predicting platinum resistance in patients with EOC.

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“…Intrahepatic cholangiocarcinoma is representative of tumor entities where resection of the primary tumor is the only option for cure, but frequent disease recurrence limits survival. 35 In general, clinical development of novel cancer therapies is expensive and time-consuming, since a large number of promising agents or strategies fail in late-stage clinical trials. Those disappointing results emphasize that preclinical animal models of reliable predictive value are urgently required, particularly for investigations of adjuvant systemic therapies.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Gemcitabine Therapy Improves Survival in A Locally Induced, R0-Resectable Model of Metastatic Intrahepatic Cholangiocarcinoma

et al. 2013

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Complete surgical tumor resection (R0) for treatment of intrahepatic cholangiocarcinoma (ICC) is potentially curative, but the prognosis remains dismal due to frequent tumor recurrence and metastasis after surgery. Adjuvant therapies may improve the outcome, but clinical studies for an adjuvant approach are difficult and time-consuming for rare tumor entities. Therefore, animal models reflecting the clinical situation are urgently needed to investigate novel adjuvant therapies. To establish a mouse model of resectable cholangiocarcinoma including the most frequent genetic alterations of human ICC, we electroporated Sleeping Beauty-based oncogenic transposon plasmids into the left liver lobe of mice. KRas-activation in combination with p53-knockout in hepatocytes resulted in formation of a single ICC nodule within 3-5 weeks. Lineage tracing analyses confirmed the development of ICC by transdifferentiation of hepatocytes. Histologic examination demonstrated that no extrahepatic metastases were detectable during primary tumor progression. However, formation of tumor satellites close to the primary tumor and vascular invasion were observed, indicating early invasion into normal tissue adjacent to the tumor. After R0-resection of the primary tumor, we were able to prolong median survival, thereby observing tumor stage-dependent local recurrence, peritoneal carcinomatosis, and lung metastasis. Adjuvant gemcitabine chemotherapy after R0-resection significantly improved median survival of treated animals. Conclusion: We have developed a murine model of single, R0-resectable ICC with favorable characteristics for the study of recurrence patterns and mechanisms of metastasis after resection. This model holds great promise for preclinical evaluation of novel multimodal or adjuvant therapies to prevent recurrence and metastasis after R0-resection. (HEPATOLOGY 2013;58:1031-1041

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Surgical treatment of intrahepatic cholangiocarcinoma: outcomes and predictive factors

Cited by 30 publications

References 14 publications

A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)

A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI)

Prognostic Significance of Preoperative Prognostic Nutritional Index in Epithelial Ovarian Cancer Patients Treated with Platinum-Based Chemotherapy

Adjuvant Gemcitabine Therapy Improves Survival in A Locally Induced, R0-Resectable Model of Metastatic Intrahepatic Cholangiocarcinoma

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