Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma

• Published in: BMC cancer Vol. 21; no. 1; pp. 1 - 708
• Main Authors: Matsuda, Tatsuo, Umeda, Yuzo, Matsuda, Tadakazu, Endo, Yoshikatsu, Sato, Daisuke, Kojima, Toru, Sui, Kenta, Inagaki, Masaru, Ota, Tetsuya, Hioki, Masayoshi, Oishi, Masahiro, Kimura, Masashi, Murata, Toshihiro, Ishido, Nobuhiro, Yagi, Takahito, Fujiwara, Toshiyoshi
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 16-06-2021; BioMed Central; BMC
• Subjects: Abdomen; Abscesses; Bile; Cancer; Care and treatment; Cholangiocarcinoma; Classification; Complications; Complications and side effects; Hepatectomy; Hospitals; Infection; Infections; Intrahepatic cholangiocarcinoma; Investigations; Liver cancer; Lymphocytes; Medical prognosis; Medical records; Metastasis; Mortality; Multivariate analysis; Neutrophils; Nutrition; Nutritional status; Pneumonia; Postoperative complication; Preoperative care; Product/Service Evaluations; Prognosis; Prognostic nutritional index; Regression analysis; Risk factors; Surgery; Survival; Survival analysis; Japan
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08424-0

Background In the surgical treatment of intrahepatic cholangiocarcinoma (ICC), postoperative complications may be predictive of long-term survival. This study aimed to identify an immune-nutritional index (INI) that can be used for preoperative prediction of complications. Patients and methods Multi-institutional data from 316 patients with ICC who had undergone surgical resection were retrospectively analysed, with a focus on various preoperative INIs. Results Severe complications (Clavien-Dindo grade III-V) were identified in 66 patients (20.8%), including Grade V complications in 7 patients (2.2%). Comparison of areas under the receiver operating characteristic curve (AUCs) among various INIs identified the prognostic nutritional index (PNI) as offering the highest predictive value for severe complications (AUC = 0.609, cut-off = 50, P = 0.008). Multivariate analysis revealed PNI < 50 (odds ratio [OR] = 2.22, P = 0.013), hilar lesion (OR = 2.46, P = 0.026), and long operation time (OR = 1.003, P = 0.029) as independent risk factors for severe complications. In comparing a high-PNI group (PNI [greater than or equai to] 50, n = 142) and a low-PNI group (PNI < 50, n = 174), the low-PNI group showed higher rates of both major complications (27% vs. 13.4%; P = 0.003) and infectious complications (14.9% vs. 3.5%; P = 0.0021). Furthermore, median survival time and 1- and 5-year overall survival rates were 34.2 months and 77.4 and 33.8% in the low-PNI group, respectively, and 52.4 months and 89.3 and 47.5% in the high-PNI group, respectively (P = 0.0017). Conclusion Preoperative PNI appears useful as an INI correlating with postoperative severe complications and as a prognostic indicator for ICC. Keywords: Intrahepatic cholangiocarcinoma, Postoperative complication, Prognostic nutritional index