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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



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.


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.


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.


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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We thank the participants of the study.


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 (, for editing the English text of a draft of this manuscript. This was funded by the corresponding author’s department.


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.


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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Correspondence to Huayu Yang or Yilei Mao.

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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).

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  • Biliary tract cancer
  • HALP
  • Nomogram
  • Prognosis