The postoperative peak number of leukocytes after hepatectomy is a significant prognostic factor for cholangiocarcinoma

Abstract

Cholangiocarcinoma (CCA) is a lethal disease. A new predictive factor to identify patients suitable for adjuvant chemotherapy is needed. The relationship between the long-term prognosis and the perioperative immune responses in patients with CCA remains unclear. We therefore investigated the clinical impact of perioperative immune responses on the long-term prognosis in patients receiving hepatectomy for CCA. We investigated 81 patients who underwent hepatectomy between February 2000 and October 2012: 57 intra-hepatic CCA (iCCA) patients and 24 extra-hepatic CCA (eCCA) patients. We checked the postoperative level of C-reactive protein and the numbers of leukocytes. A multivariate analysis of the clinicopathological factors identified 2 significant risk factors for the overall survival: The postoperative maximum number of leukocytes (PNL) among patient factors (P=0.0406) and the TNM-stage among tumor factors (P=0.0059). On evaluating the distribution of each kind of leukocyte with a multivariate analysis, both the postoperative maximum number of neutrophils (PNN) and the postoperative maximum number of eosinophils (PNE) were detected as significant factors among leukocytes (PNN/PNE, P=0.0367/0.0083). In conclusion, the PNL after hepatectomy was significantly associated with the long-term prognosis in patients with CCA. Changes in the numbers of leukocytes after hepatectomy may be a marker on treatment for CCA.

Keywords: cholangiocarcinoma; eosinophil; hepatectomy; leucocyte; neutrophil.

Figure 1.

The long-term prognosis of patients after hepatectomy for cholangiocarcinoma (CCA). (A) The overall survival (OS, upper left), disease-free survival (DFS, upper right) and survival after recurrence (SAR, lower left) curves after surgery for 81 patients with CCA. Patients were divided into two groups according to the median postoperative peak number of neutrophils. The median OS in the high-neutrophil group (n=40) and low-neutrophil group (n=41) was 43.1 and 59.2 months, respectively; P=0.0406. The median DFS in the high-neutrophil group and low-neutrophil group was 16.1 and 25. months, respectively; P=0.8809. The median SAR in the high-neutrophil group and low-neutrophil group was 11.0 and 18.8 months, respectively; 0.0318. (B) The OS (upper left), DFS (upper right) and SAR (lower left) curves after surgery for 81 patients with CCA. Patients were divided into two groups according to the median postoperative peak number of eosinophils. The median OS in the high-eosinophil group (n=40) and low-eosinophil group (n=41) was 74.8 and 30.3 months, respectively; P=0.0111. The median DFS in the high-eosinophil group and low-eosinophil group was 27.3 and 13.8 months, respectively; P=0.2334. The median SAR in the high-eosinophil group and low-eosinophil group was 22.8 and 11.0 months, respectively; P=0.0086.