Abstract
Introduction
Biliary tract cancer (BTC) comprises infrequently occurring neoplasms with poor prognoses. Red blood cell-related parameters are commonly reported prognostic factors. We aimed to compare and evaluate the clinical value of red blood cell-related parameters and develop a prognostic nomogram.
Methods
The analysis involved 418 patients with BTC who underwent surgery from December 2003 to April 2017. Patients were divided into training and validation cohorts. Red blood cell-related parameters were compared using Kaplan-Meier analysis, the area under receiver-operating characteristic curve (AUC), and C-index. Predictive abilities were evaluated using Cox regression. We developed a nomogram incorporating superior parameters verified using calibration curves, internal validation, and subgroup analysis. The nomogram was compared with the tumour-node-metastasis staging system through ROC, C-index, and Kaplan-Meier analysis.
Results
A combined parameter comprising haemoglobin, albumin, lymphocytes, and platelets (HALP), which was superior to other red blood cell-related parameters, indicated a high risk of worse overall survival when low. Univariate analysis revealed that HALP together with other clinical characteristics was associated with overall survival. Multivariate analysis revealed that HALP, tumour-node-metastasis staging, and operative outcome were independent predictors of poor overall survival. Internal validation proved the predictive value of the nomogram. Additional statistical analyses established the advantages of the nomogram vs. tumour-node-metastasis staging.
Conclusion
HALP was a superior red blood cell-related parameter and an independent predictor of prognosis. Our nomogram based on HALP, tumour-node-metastasis staging, and operative outcome is a promising model for predicting overall survival.
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References
Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. 2014;383(9935):2168–79.
Patel T. Cholangiocarcinoma–controversies and challenges. Nat Rev Gastroenterol Hepatol. 2011;8(4):189–200.
Perinel J, Adham M. Preoperative biliary drainage for resectable or borderline resectable periampullary tumor: what is the best management? Hepatob Surg Nutr. 2019;8(4):398–400.
Xue L, Guo C, Zhang K, Jiang H, Pang F, Dou Y, et al. Comprehensive molecular profiling of extrahepatic cholangiocarcinoma in Chinese population and potential targets for clinical practice. Hepatob Surg Nutr. 2019;8(6):615–22.
Lepage C, Cottet V, Chauvenet M, Phelip JM, Bedenne L, Faivre J, et al. Trends in the incidence and management of biliary tract cancer: a French population-based study. J Hepatol. 2011;54(2):306–10.
Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz J, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234(5):507–19.
Zhang XF, Beal EW, Bagante F, Chakedis J, Weiss M, Popescu I, et al. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent. Br J Surg. 2018;105(7):848–56.
Ma WJ, Wu ZR, Shrestha A, Yang Q, Hu HJ, Wang JK, et al. Effectiveness of additional resection of the invasive cancer-positive proximal bile duct margin in cases of hilar cholangiocarcinoma. Hepatob Surg Nutr. 2018;7(4):251–69.
Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.
Tang LQ, Li CF, Li J, Chen WH, Chen QY, Yuan LX, et al. Establishment and validation of prognostic nomograms for endemic nasopharyngeal carcinoma. J Natl Cancer Inst. 2016;108(1).
Ficarra V, Galfano A, Novara G, Iafrate M, Brunelli M, Secco S, et al. Risk stratification and prognostication of renal cell carcinoma. World J Urol. 2008;26(2):115–25.
Yoshida N, Kosumi K, Tokunaga R, Baba Y, Nagai Y, Miyamoto Y, et al. Clinical importance of mean corpuscular volume as a prognostic marker after esophagectomy for esophageal cancer. Ann Surg. 2020;271(3):494–501.
Zhang X, Zhang F, Qiao W, Zhang X, Zhao Z, Li M. Low hematocrit is a strong predictor of poor prognosis in lung cancer patients. Biomed Res Int. 2018;2018:6804938.
Koma Y, Onishi A, Matsuoka H, Oda N, Yokota N, Matsumoto Y, et al. Increased red blood cell distribution width associates with cancer stage and prognosis in patients with lung cancer. PLoS One. 2013;8(11):e80240.
Xu SS, Li S, Xu HX, Li H, Wu CT, Wang WQ, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol. 2020;26(8):828–38.
Bozkaya Y, Kurt B, Gurler F. A prognostic parameter in advanced non-small cell lung cancer: the ratio of hemoglobin-to-red cell distribution width. Int J Clin Oncol. 2019;24(7):798–806.
J. B, A. L, H. W. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2015.
Association WM. World medical association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.
Peng D, Zhang CJ, Gong YQ, Hao H, Guan B, Li XS, et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy. Sci Rep. 2018;8(1):794.
Li J, Chen S, Peng S, Liu Y, Xing S, He X, et al. Prognostic nomogram for patients with Nasopharyngeal Carcinoma incorporating hematological biomarkers and clinical characteristics. Int J Biol Sci. 2018;14(5):549–56.
Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer. 2010;116(18):4256–65.
Chakedis J, Spolverato G, Beal EW, Woelfel I, Bagante F, Merath K, et al. Pre-operative sarcopenia identifies patients at risk for poor survival after resection of biliary tract cancers. J Gastrointest Surg. 2018;22(10):1697–708.
Jansson H, Cornillet M, Bjorkstrom NK, Sturesson C, Sparrelid E. Prognostic value of preoperative inflammatory markers in resectable biliary tract cancer—validation and comparison of the Glasgow Prognostic Score and Modified Glasgow Prognostic Score in a Western cohort. Eur J Surg Oncol. 2020;46(5):804–10.
Cho K-M, Han S-W, Park H, Im S-A, Oh D-Y, Kim T-Y, et al. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and their dynamic changes during chemotherapy is useful to predict a more accurate prognosis of advanced biliary tract cancer. Oncotarget. 2016;8(2):2329–41
Nakashima S, Kobayashi S, Nagano H, Tomokuni A, Tomimaru Y, Asaoka T, et al. BRCA/Fanconi anemia pathway implicates chemoresistance to gemcitabine in biliary tract cancer. Cancer Sci. 2015;106(5):584–91.
Alvaro Sanz E, Garrido Siles M, Rey Fernandez L, Villatoro Roldan R, Rueda Dominguez A, Abiles J. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: early intervention protocol. Nutrition. 2019;57:148–53.
Yang X-w, Yuan J-m, Chen J-y, Yang J, Gao Q-g, Yan X-z, et al. The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer. BMC Cancer. 2014;14.
Acknowledgements
We thank the participants of the study.
Funding
This work was supported by grants from CAMS Innovation Fund for Medical Sciences (CIFMS) (no. 2016-I2M-1–001), the Fundamental Research Funds for the Central Universities (3332020085), and Tsinghua University-Peking Union Medical College Hospital Cooperation Project (PTQH201904552). The journal’s rapid service fee was paid for by the authors.
Editorial Assistance
We thank Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript. This was funded by the corresponding author’s department.
Authorship
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Authorship Contributions
Conceptualization, L.S., A.G., Y.J., H.Y. and Y.M.; methodology, M.L, Y.X., H.X., S.D., H.Z., X.L., X.S., S.Z.; software, A.G..; validation, Y.M.; formal analysis, L.S., A.G.; writing-original draft preparation, L.S., A.G.; writing-review and editing, L.S.; supervision, Y.M.
Disclosures
L.S., A.G., Y.J., M.L., Y.X., H.X., S.D., H.Z., X.L., X.S., S.Z., H.Y., and Y.M. have nothing to disclose.
Compliance with Ethics Guidelines
The Medical Ethics Committees of Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College approved the study, which was conducted in accordance with the ethical standards of the World Medical Association’s Declaration of Helsinki [18]. The requirement for informed consent was waived because this was a retrospective study.
Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Sun, L., Guan, A., Jin, Y. et al. Comparison of Prognostic Value of Red Cell-Related Parameters of Biliary Tract Cancer After Surgical Resection and Integration of a Prognostic Nomogram: A Retrospective Study. Adv Ther 38, 1227–1244 (2021). https://doi.org/10.1007/s12325-020-01595-5
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DOI: https://doi.org/10.1007/s12325-020-01595-5