Prediction Efficacy of Prognostic Nutritional Index and Albumin-Bilirubin Grade in Patients With Intrahepatic Cholangiocarcinoma After Radical Resection: A Multi-Institutional Analysis of 535 Patients

Qi Li; Chen Chen; Jian Zhang; Hong Wu; Yinghe Qiu; Tianqiang Song; Xianhai Mao; Yu He; Zhangjun Cheng; Wenlong Zhai; Jingdong Li; Dong Zhang; Zhimin Geng; Zhaohui Tang

doi:10.3389/fonc.2021.769696

Prediction Efficacy of Prognostic Nutritional Index and Albumin-Bilirubin Grade in Patients With Intrahepatic Cholangiocarcinoma After Radical Resection: A Multi-Institutional Analysis of 535 Patients

Front Oncol. 2021 Dec 10:11:769696. doi: 10.3389/fonc.2021.769696. eCollection 2021.

Authors

Qi Li¹, Chen Chen¹, Jian Zhang¹, Hong Wu², Yinghe Qiu³, Tianqiang Song⁴, Xianhai Mao⁵, Yu He⁶, Zhangjun Cheng⁷, Wenlong Zhai⁸, Jingdong Li⁹, Dong Zhang¹, Zhimin Geng¹, Zhaohui Tang¹⁰

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Hepatobiliary and Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.
³ Department of Biliary Surgery, Oriental Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai, China.
⁴ Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, Tianjin, China.
⁵ Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha, China.
⁶ Department of Hepatobiliary Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, China.
⁷ Department of Hepatobiliary Surgery, Zhongda Hospital of Southeast University, Nanjing, China.
⁸ Hepatobiliary Pancreas and Liver Transplantation Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁹ Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
¹⁰ Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Abstract

Background: The preoperative nutritional status and the immunological status have been reported to be independent prognostic factors of patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to investigate whether prognostic nutritional index (PNI) + albumin-bilirubin (ALBI) could be a better predictor than PNI and ALBI alone in patients with ICC after radical resection.

Methods: The prognostic prediction evaluation of the PNI, ALBI, and the PNI+ALBI grade was performed in 373 patients with ICC who underwent radical resection between 2010 and 2018 at six Chinese tertiary hospitals, and external validation was conducted in 162 patients at four other Chinese tertiary hospitals. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan-Meier method. Multivariate analysis was conducted to identify independent prognostic factors. A time-dependent receiver operating characteristic (ROC) curve and a nomogram prediction model were further constructed to assess the predictive ability of PNI, ALBI, and the PNI+ALBI grade. The C-index and a calibration plot were used to assess the performance of the nomogram models.

Results: Univariate analysis showed that PNI, ALBI, and the PNI+ALBI grade were prognostic factors for the OS and RFS of patients with ICC after radical resection in the training and testing sets (p < 0.001). Multivariate analysis showed that the PNI+ALBI grade was an independent risk factor for OS and RFS in the training and testing sets (p < 0.001). Analysis of the relationship between the PNI+ALBI grade and clinicopathological characteristics showed that the PNI+ALBI grade correlated with obstructive jaundice, alpha-fetoprotein (AFP), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), PNI, ALBI, Child-Pugh grade, type of resection, tumor size, major vascular invasion, microvascular invasion, T stage, and N stage (p < 0.05). The time-dependent ROC curves showed that the PNI+ALBI grade had better prognostic predictive ability than the PNI, ALBI, and the Child-Pugh grade in the training and testing sets.

Conclusion: Preoperative PNI+ALBI grade is an effective and practical predictor for the OS and RFS of patients with ICC after radical resection.

Keywords: PNI+ALBI grade; albumin–bilirubin grade; intrahepatic cholangiocarcinoma; nomogram; prognostic nutritional index.