Elevated NLR in gallbladder cancer and cholangiocarcinoma - making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium.
Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers.



Patients who underwent complete surgical resection between 2000-2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR.



Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer.



Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Eliza W
EW
Beal
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Lai
L
Wei
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Cecilia G
CG
Ethun
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Sylvester M
SM
Black
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
Mary
M
Dillhoff
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed
A
Salem
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sharon M
SM
Weber
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Thuy
T
Tran
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
George
G
Poultsides
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Andre Y
AY
Son
Department of Surgery, New York University, New York, NY, USA.
Ioannis
I
Hatzaras
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Linda
L
Jin
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Ryan C
RC
Fields
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Stefan
S
Buettner
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Timothy M
TM
Pawlik
Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
Charles
C
Scoggins
Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
Robert C G
RC
Martin
Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Chelsea A
CA
Isom
Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Kamron
K
Idrees
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Harveshp D
HD
Mogal
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Perry
P
Shen
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Shishir K
SK
Maithel
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. Electronic address: Carl.Schmidt@osumc.edu.
Carl R
CR
Schmidt
D000046:Academic Medical Centers; D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005706:Gallbladder Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
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