Tumour burden score combined with albumin-to-alkaline phosphatase ratio predicts prognosis in patients with intrahepatic cholangiocarcinoma

Abstract

Tumour morphology (tumour burden score (TBS)) and liver function (albumin-to-alkaline phosphatase ratio (AAPR)) have been shown to correlate with outcomes in intrahepatic cholangiocarcinoma (ICC). This study aimed to evaluate the combined predictive effect of TBS and AAPR on survival outcomes in ICC patients. We conducted a retrospective analysis using a multicentre database of ICC patients who underwent curative surgery from 2011 to 2018. The Kaplan-Meier method was employed to examine the relationship between a new index (combining TBS and AAPR) and long-term outcomes. The predictive efficacy of this index was compared to other conventional indicators. A total of 560 patients were included in the study. Based on TBS and AAPR stratification, patients were classified into three groups. Kaplan-Meier curves demonstrated that 124 patients with low TBS and high AAPR had the best overall survival (OS) and recurrence-free survival (RFS), while 170 patients with high TBS and low AAPR had the worst outcomes (log-rank p < 0.001). Multivariate analyses identified the combined index as an independent predictor of OS and RFS. Furthermore, the index showed superior accuracy in predicting OS and RFS compared to other conventional indicators. Collectively, this study demonstrated that the combination of liver function and tumour morphology provides a synergistic effect in evaluating the prognosis of ICC patients. The novel index combining TBS and AAPR effectively stratified postoperative survival outcomes in ICC patients undergoing curative resection.

Keywords: albumin‐to‐alkaline phosphatase ratio; curative resection; intrahepatic cholangiocarcinoma; long‐term outcome; tumour burden score.

FIGURE 1

Kaplan–Meier curves demonstrating differences in overall survival (OS) (A) and recurrence‐free survival (RFS) (B) among patients stratified by tumour burden score (TBS) and albumin‐to‐alkaline phosphatase ratio (AAPR). Groups include low TBS/high AAPR, low TBS/low AAPR, high TBS/high AAPR and high TBS/low AAPR.

FIGURE 2

Comparison of AUC values for combined TBS and AAPR, tumour number, CA19‐9, lymph node invasion and microvascular invasion in predicting OS (A) and RFS (B). AUC, area under the receiver operating characteristic curve; AAPR, albumin‐to‐alkaline phosphatase ratio; CA19‐9, carbohydrate antigen 19‐9; MVI, microvascular invasion; TBS, tumour burden score.