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. 2020 Feb;24(2):330-340.
doi: 10.1007/s11605-018-04086-9. Epub 2019 Jan 22.

Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Dingzhong Peng  1 , Jiong Lu  1 , Haijie Hu  1 , Bei Li  1 , Xiwen Ye  1 , Nansheng Cheng  2
Affiliations

Lymphocyte to Monocyte Ratio Predicts Resectability and Early Recurrence of Bismuth-Corlette Type IV Hilar Cholangiocarcinoma

Dingzhong Peng et al. J Gastrointest Surg. 2020 Feb.

Abstract

Background: The objective of our research was to investigate the value of the lymphocyte to monocyte ratio (LMR) and its dynamic changes (LMRc) in predicting tumor resectability and early recurrence of radiologically resectable type IV hilar cholangiocarcinoma (HC).

Methods: A total of 411 patients with radiologically resectable type IV HC were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. Receiver operating characteristic (ROC) analysis was conducted to assess the ability of preoperative LMR (pre-LMR) to predict tumor resectability, and the ability of postoperative LMR (post-LMR) to discriminate between early and late recurrence. Survival curves were calculated using the Kaplan-Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with resectability and early recurrence.

Results: Of 411 patients with potentially curative type IV HC, 254 underwent curative surgery. The optimal cutoff value of pre-LMR as an indicator of resectability was 3.67, and the optimal cutoff value of post-LMR for detecting early recurrence was 4.10. In the multivariate logistic regression model, CA19-9 > 200 U/mL, pre-LMR ≤ 3.67, and tumor size > 3 cm were found to be independent risk factors for poor resectability. Moreover, multivariate analysis showed that LMRc, resection margin, AJCC N stage, and lymphovascular invasion were independent risk factors associated with early recurrence.

Discussion: Pre-LMR is a valuable indicator of resectability and LMRc is a valuable predictor of early recurrence in patients with curative type IV HC.

Keywords: Bismuth-Corlette classification; Early recurrence; Hilar cholangiocarcinoma; Lymphocyte to monocyte ratio; Resectability.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis showing overall survival in patients with resectable and unresectable type IV HC
Fig. 2
Fig. 2
Recurrence rate after curative-intent surgery for type IV HC patients at 6-month interval
Fig. 3
Fig. 3
a The 5-year disease-free survival rate of the low LMR group was significantly lower than that of the high LMR group; b the 5-year overall survival rate of the high LMR group was significantly higher than that of the low LMR group
Fig. 4
Fig. 4
a ROC analysis of pre-LMR for determining the resectability for radiologically resectable type IV HC; b ROC analysis of post-LMR for determining early recurrence of resectable type IV HC after curative resection
See this image and copyright information in PMC

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