Scientific Publications Database
Article Title: Preoperative prognostic nutritional index predicts survival of patients with intrahepatic cholangiocarcinoma after curative resectionAuthors: Akguel, Ozguer; Bagante, Fabio; Olsen, Griffin; Cloyd, Jordan M.; Weiss, Matthew; Merath, Katiuscha; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Soubrane, Olivier; Martel, Guillaume; Koerkamp, B. Groot; Guglielmi, Alfredo; Itaru, Endo; Pawlik, Timothy M.
Journal: JOURNAL OF SURGICAL ONCOLOGY Volume 118 Issue 3
Date of Publication:2018
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.