Prognostic Impact of Inflammation-Based Scores for Extrahepatic Cholangiocarcinoma

Prognostic value of the modified Glasgow prognostic score in biliary tract cancer patients: a systematic review and meta-analysis

BACKGROUND

Biliary tract cancer (BTC) is an invasive adenocarcinoma affecting the hepatobiliary system, but high recurrence rates highlight the need for more effective adjuvant approaches. The modified Glasgow prognostic score (mGPS) has been explored as an independent prognostic indicator in patients with BTC. However, consensus on its prognostic value is lacking. This meta-analysis aimed to comprehensively assess the association between mGPS and diverse clinical outcomes in BTC by systematically analyzing relevant studies.

METHODS

A systematic search approach was used to look for eligible papers published until June 2023 in PubMed, Web of Science, and Embase, with a focus on overall survival (OS) and disease-free/recurrence-free survival (DFS/RFS). The prognostic potential of mGPS was assessed using hazard ratios (HRs) with corresponding 95% CIs.

RESULTS

A total of 15 papers comprising 2447 patients were included in this meta-analysis. The results demonstrated that, in patients with BTC, the high mGPS was associated with poorer OS (HR=1.49, 95% CI=1.35-1.65, P<0.001) and DFS/RFS (HR=3.23, 95%CI=1.98-5.26, P=0.193).

CONCLUSION

According to this meta-analysis, our study found that high mGPS was associated with poorer OS and DFS/RFS in patients with BTC.

Prognostic role of the controlling nutritional status (CONUT) score in patients with biliary tract cancer: a meta-analysis

BACKGROUND

Previous reports have not reached consistent results regarding the prognostic significance of the controlling nutritional status (CONUT) score in biliary tract cancer (BTC). Therefore, the present meta-analysis was conducted to investigate the precise role of the CONUT score in predicting the prognosis of BTC.

METHODS

Electronic platforms including Web of Science, PubMed, Cochrane Library, and Embase were comprehensively searched up to May 2, 2023. We also determined combined hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the role of the CONUT score in predicting the prognosis of patients with BTC.

RESULTS

Ten studies involving 1,441 patients were included in the present study. Nine studies treated patients with surgical resection, and one study used percutaneous transhepatic biliary stenting (PTBS) plus 125I seed intracavitary irradiation. Based on the combined data, a higher CONUT score significantly predicted dismal overall survival (OS) (HR = 1.94, 95%CI = 1.41-2.66, p < 0.001), inferior recurrence-free survival (RFS) (HR = 1.79, 95%CI = 1.48-2.17, p < 0.001) in BTC, and low differentiation (OR = 1.57, 95%CI = 1.15-2.14, p = 0.004). Nonetheless, the CONUT score was not related to sex, lymph node metastasis, microvascular invasion, perineural invasion, distant metastasis, TNM stage, or tumor number in patients with BTC.

CONCLUSION

Higher CONUT scores significantly predicted worse OS and RFS in patients with BTC. Moreover, BTC patients with high CONUT scores tended to have poor tumor differentiation. The CONUT score could help clinicians stratify high-risk patients with BTC and devise individualized treatment plans.

Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review

This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.

Development and validation of a gene expression-based nomogram to predict the prognosis of patients with cholangiocarcinoma

AIM

To establish and validate a prognostic nomogram of cholangiocarcinoma (CCA) using independent clinicopathological and genetic mutation factors.

METHODS

213 patients with CCA (training cohort n = 151, validation cohort n = 62) diagnosed from 2012 to 2018 were included from multi-centers. Deep sequencing targeting 450 cancer genes was performed. Independent prognostic factors were selected by univariate and multivariate Cox analyses. The clinicopathological factors combined with (A)/without (B) the gene risk were used to establish nomograms for predicting overall survival (OS). The discriminative ability and calibration of the nomograms were assessed using C-index values, integrated discrimination improvement (IDI), decision curve analysis (DCA), and calibration plots.

RESULTS

The clinical baseline information and gene mutations in the training and validation cohorts were similar. SMAD4, BRCA2, KRAS, NF1, and TERT were found to be related with CCA prognosis. Patients were divided into low-, median-, and high-risk groups according to the gene mutation, the OS of which was 42.7 ± 2.7 ms (95% CI 37.5-48.0), 27.5 ± 2.1 ms (95% CI 23.3-31.7), and 19.8 ± 4.0 ms (95% CI 11.8-27.8) (p < 0.001), respectively. The systemic chemotherapy improved the OS in high and median risk groups, but not in the low-risk group. The C-indexes of the nomogram A and B were 0.779 (95% CI 0.693-0.865) and 0.725 (95% CI 0.619-0.831), p < 0.01, respectively. The IDI was 0.079. The DCA showed a good performance and the prognostic accuracy was validated in the external cohort.

CONCLUSION

Gene risk has the potential to guide treatment decision for patients at different risks. The nomogram combined with gene risk showed a better accuracy in predicting OS of CCA than not.

Prognostic impact of the Controlling Nutritional Status Score in patients with biliary tract cancer: a systematic review and meta-analysis

Background

Biliary tract cancer (BTC) is a malignancy associated with unfavorable outcomes. Advanced BTC patients have a propensity to experience compromised immune and nutritional status as a result of obstructive jaundice and biliary inflammation. Currently, there is a lack of consensus on the impact of the Controlling Nutritional Status (CONUT) score in the context of BTC prognosis. The purpose of this study is to conduct a meta-analysis on the association between CONUT and the prognosis of patients suffering from BTC.

Methods

A defined search strategy was implemented to search the PubMed, Embase, and Web of Science databases for eligible studies published until March 2023, with a focus on overall survival (OS), relapse-free survival/recurrence-free survival(RFS), and relevant clinical characteristics. The prognostic potential of the CONUT score was evaluated using hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).

Results

In this meta-analysis, a total of 1409 patients from China and Japan were involved in 9 studies. The results indicated that the CONUT score was significantly correlated with worse OS (HR=2.13, 95% CI 1.61-2.82, P<0.0001) and RFS (HR=1.83, 95% CI 1.44-2.31, P<0.0001) in patients with BTC. And, the analysis showed that a high CONUT score was significantly associated with clinical characteristics such as jaundice (OR=1.60, 95% CI=1.14-2.25, P=0.006), poorly differentiated tumor (OR=1.43, 95% CI=1.03-1.99, P=0.03), pT3 and 4 stage of the tumor (OR=1.87, 95% CI=1.30-2.68, P=0.0007), and complications of Clavien-Dindo classification grade IIIa or higher (OR=1.79, 95% CI=1.03-3.12, P=0.04).

Conclusion

This meta-analysis indicates that a high CONUT score can serve as a significant prognostic indicator for survival outcomes among patients diagnosed with BTC.

Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients with Bile Duct Cancer: A Meta-Analysis

Recent studies have explored the prognostic role of the C-reactive protein to albumin ratio (CAR) in patients with bile duct cancer (BTC), but the results have been inconsistent. This study aimed to provide insight into the prognostic significance of the CAR in BTC prior to treatment using a meta-analysis. Summarized hazard ratios (HRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for prognosis and clinicopathological features using fixed or random effects models. Fourteen studies with a total of 1,543 subjects were included in this meta-analysis. Elevated CAR was significantly associated with poor overall survival (HR = 2.17, 95% CI = 1.81-2.60, P < 0.001) and decreased disease-free survival or recurrence-free survival (HR = 2.53, 95% CI = 1.98-3.25, P < 0.001) in BTC. In addition, high CAR was significantly associated with the presence of lymph node metastasis (OR = 1.54, 95% CI = 1.12- 2.13, P = 0.008), bile duct invasion (OR = 2.64, 95% CI = 1.54-4.54, P < 0.001), and tumor stages III-IV (OR = 3.11, 95% CI = 1.05-9.20, P = 0.040). However, there was no significant association between CAR and sex, microvascular invasion, or resection. An elevated CAR was significantly related to worse long-term and short-term survival and advanced clinicopathological features of BTC. CAR could serve as a valuable, noninvasive prognostic marker in patients with BTC.