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Development and Validation of a Laboratory Risk Score (LabScore) to Predict Outcomes after Resection for Intrahepatic Cholangiocarcinoma. Journal of the American College of Surgeons Tsilimigras, D. I., Mehta, R. n., Aldrighetti, L. n., Poultsides, G. A., Maithel, S. K., Martel, G. n., Shen, F. n., Koerkamp, B. G., Endo, I. n., Pawlik, T. M. 2020

Abstract

Estimating prognosis in the preoperative setting is challenging as most survival risk scores rely exclusively on postoperative factors. We sought to develop a composite score that incorporated preoperative liver, tumor, nutritional and inflammatory markers to predict long-term outcomes following resection of intrahepatic cholangiocarcinoma (ICC).Patients who underwent curative-intent hepatectomy for ICC between 2000-2017 were identified using an international multi-institutional database. Clinico-pathologic factors were assessed using bivariate and multivariable analysis and a prognostic model to estimate overall survival (OS) based only on preoperative laboratory values (LabScore) was developed and validated.Among 660 patients, median and 5-year OS were 43.2 months and 42.4%, respectively. On multivariable analysis, laboratory values associated with OS included carbohydrate antigen (CA) 19-9 (HR=1.16, 95%CI 1.05-1.27), neutrophil-to-lymphocyte ratio (NLR)(HR=1.09, 95%CI 1.05-1.13), platelet count (PLT)(HR=1.01, 95%CI 1.00-1.01) and albumin (HR=0.75, 95%CI 0.62-0.92). A weighted LabScore was constructed based on the formula: (8.2 + 1.45*lnCA19-9 + 0.84*NLR + 0.03*PLT-2.83*Albumin). Patients with a LabScore of 0-9 (n=223), 10-19 (n=353) and >20 (n=88) had an incrementally worse 5-year OS of 54.9%, 38.2% and 21.6%, respectively (p<0.001). The model demonstrated good performance in both the test (c-index: 0.70) and validation cohorts (c-index: 0.67), as well as outperformed individual laboratory markers, the prognostic nutritional index (c-index: 0.58) and 8th edition AJCC staging (c-index: 0.60).A preoperative LabScore was able to predict long-term outcomes of patients following resection for ICC better than AJCC staging system. The LabScore can be used to preoperatively identify patients who will benefit the most from upfront surgery or alternative treatment options including neoadjuvant chemotherapy prior to resection.

View details for DOI 10.1016/j.jamcollsurg.2019.12.025

View details for PubMedID 32014569