BackgroundIntrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. MethodsPatients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI40 and <40 were compared using univariable and multivariable analyses. ResultsAmong 637 patients, 53 patients had PNI<40 (8.3%) and 584 patients had PNI40 (91.7%). While there was no difference between PNI groups with regard to tumor size (P=.87), patients with PNI<40 were more likely to have multifocal disease (PNI<40, n=16, 30.2% vs PNI40, n=65, 11.1%; P<0.001), poorly differentiated or undifferentiated ICC (PNI<40, n=13, 25.5% vs PNI40, n=75, 13.1%; P=0.020) and T2/T3/T4 disease vs patients with PNI40 (PNI<40, n=38, 71.7% vs PNI40, n=265, 45.4%; P<0.001). Patients with PNI40 had better OS vs patients with PNI<40 (5-year OS: PNI40: 47.5%, 95% CI, 42.2 to 52.6% vs PNI<40: 24.6%, 95% CI, 12.1 to 39.6%; P<0.001). On multivariable analysis, PNI<40 remained associated with increase risk of death (HR, 1.71; 95% CI, 1.15 to 2.53; P=0.008). ConclusionA low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.
Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection / Akgul, O., Bagante, F., Olsen, G., Cloyd, J.m., Weiss, M., Merath, K., Alexandrescu, S., Marques, H.p., Aldrighetti, L., Maithel, S.k., Pulitano, C., Bauer, T.w., Shen, F., Poultsides, G.a., Soubrane, O., Martel, G., Koerkamp, B.g., Guglielmi, A., Itaru, E., Pawlik, T.m.. - In: JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0022-4790. - 118:3(2018), pp. 422-430. [10.1002/jso.25140]
Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resection
Aldrighetti L;
2018-01-01
Abstract
BackgroundIntrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy. We sought to examine the association between preoperative prognostic nutritional index (PNI) and long-term overall survival among patients with ICC who underwent curative-intent resection. MethodsPatients who underwent hepatectomy for ICC between 1990 and 2015 were identified using an international multi-institutional database. Clinic-pathological characteristics and long-term outcomes of patients with PNI40 and <40 were compared using univariable and multivariable analyses. ResultsAmong 637 patients, 53 patients had PNI<40 (8.3%) and 584 patients had PNI40 (91.7%). While there was no difference between PNI groups with regard to tumor size (P=.87), patients with PNI<40 were more likely to have multifocal disease (PNI<40, n=16, 30.2% vs PNI40, n=65, 11.1%; P<0.001), poorly differentiated or undifferentiated ICC (PNI<40, n=13, 25.5% vs PNI40, n=75, 13.1%; P=0.020) and T2/T3/T4 disease vs patients with PNI40 (PNI<40, n=38, 71.7% vs PNI40, n=265, 45.4%; P<0.001). Patients with PNI40 had better OS vs patients with PNI<40 (5-year OS: PNI40: 47.5%, 95% CI, 42.2 to 52.6% vs PNI<40: 24.6%, 95% CI, 12.1 to 39.6%; P<0.001). On multivariable analysis, PNI<40 remained associated with increase risk of death (HR, 1.71; 95% CI, 1.15 to 2.53; P=0.008). ConclusionA low preoperative PNI was associated with a more aggressive ICC phenotype. After controlling for these factors, PNI remained independently associated with a markedly worse prognosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
