title: Evaluation of inflammation-based prognostic scores in patients undergoing hepatobiliary resection for perihilar cholangiocarcinoma.
abstract: BACKGROUND
  Inflammation-based prognostic scores have prognostic value in several kinds of cancer. However, little is known about their value in perihilar cholangiocarcinoma. We evaluated whether inflammation-based prognostic scores are associated with survival of patients with perihilar cholangiocarcinoma.
  
  
  METHODS
  Inflammation-based scores (i.e., the modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and prognostic nutritional index) were retrospectively evaluated in 534 patients who underwent resection for perihilar cholangiocarcinoma. Blood samples obtained 1-3 days before surgery after jaundice had fully resolved with biliary drainage and after cholangitis had subsided were used to obtain the scores.
  
  
  RESULTS
  Of the four scores evaluated, the mGPS showed prognostic value, whereas the remaining three scores did not. Patients with an mGPS of 0 had significantly better survival than patients with an mGPS of 1 or 2 (41.9 % vs 26.3 % at 5 years, P < 0.001). An mGPS of 1 or 2 was significantly associated with a higher incidence of preoperative cholangitis, node metastasis, and distant metastasis (pM). Irrespective of the absence (n = 442) or presence (n = 92) of preoperative cholangitis, the survival of patients with an mGPS of 0 was significantly better than that of patients with an mGPS of 1 or 2. Multivariate analysis revealed that the mGPS, blood transfusion, histologic grade, curability (R status), lymph node metastasis, and distant metastasis were independent prognostic factors.
  
  
  CONCLUSIONS
  As in other solid cancers, the mGPS is an independent prognostic factor in resected perihilar cholangiocarcinoma. This simple and inexpensive scoring system plays an important role in refining patient stratification and predicting survival.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Okuno
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizuno
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Junpei
authors.initials: J
authors.lastname: Yamaguchi
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. nagino@med.nagoya-u.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D014408:Biomarkers, Tumor / Q000097:blood*; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000378:metabolism; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: C-reactive protein; Glasgow Prognostic Score; Prognosis; Surgical treatment; Systemic inflammatory response