title: Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  To analyse the results and prognostic factors affecting disease-free and overall survival following potentially curative resection for intrahepatic cholangiocarcinoma (IHCC).
  
  
  METHODS
  Patients undergoing resection for IHCC from January 1996 to December 2006 were included. Data analysed included demographics, clinical and histopathology data.
  
  
  RESULTS
  Twenty-seven patients were identified with a median age of 57 (32-84) years. The 1-, 3- and 5-year overall and disease-free survival rates were 74%, 16% and 16%, and 44%, 15% and 15%, respectively. On univariate analysis, age <65 years, female gender, neutrophil to lymphocyte ratio (NLR) >or= 5, micro-vascular invasion and lymph node involvement were predictors of poorer overall survival. Multivariate analysis did not identify any independent predictors of overall survival. A NLR >or= 5 was the only adverse predictor of disease-free survival. The median disease-free survival of patients with NLR >or= 5 was 6 months compared to 18 months for those with NLR < 5. There was a significant association between patients with a NLR >or= 5 and larger tumour size, satellite lesions, micro-vascular invasion and lymph node involvement.
  
  
  CONCLUSIONS
  Long-term outcome following resection of IHCC is poor. A pre-operative NLR >or= 5 was an adverse predictor of disease-free survival and was associated with an aggressive tumour biology profile.
authors.affiliation: Hepatobiliary and Transplantation Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome