Prognostic markers including immune and inflammatory factors predict outcomes in patients receiving postoperative radiation therapy for cholangiocarcinoma

Purpose This study aimed to analyze treatment outcomes and prognostic markers, including immune and inflammatory factors, of postoperative radiation therapy (RT) administered to patients with cholangiocarcinoma (CCA). Methods We retrospectively included 59 patients with CCA who underwent surgery and...

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Published in:Asia-Pacific journal of clinical oncology 2023-02, Vol.19 (1), p.226-233
Main Authors: Mukai, Yuki, Matsuyama, Ryusei, Sugiura, Madoka, Yabushita, Yasuhiro, Taniuchi, Risa, Homma, Yuki, Hashimoto, Kotaro, Miyake, Kentaro, Tabuchi, Yuya, Endo, Itaru, Hata, Masaharu
Format: Article
Language:English
Subjects:
Bile Duct Neoplasms - radiotherapy
Bile Duct Neoplasms - surgery
Bile Ducts, Intrahepatic
Blood Platelets - pathology
Cell number
Chemotherapy
Cholangiocarcinoma
Cholangiocarcinoma - radiotherapy
Cholangiocarcinoma - surgery
external beam radiation therapy
Hemoglobin
Humans
Inflammation
Leukocytes (neutrophilic)
Lymph nodes
lymphocyte count ratio
Lymphocytes
Lymphocytes - pathology
Medical prognosis
Metastases
Multivariate analysis
Neutrophils - pathology
Patients
Platelets
postoperative radiation therapy
Prognosis
Radiation therapy
Retrospective Studies
three‐dimensional radiation therapy
Toxicity
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Summary:Purpose This study aimed to analyze treatment outcomes and prognostic markers, including immune and inflammatory factors, of postoperative radiation therapy (RT) administered to patients with cholangiocarcinoma (CCA). Methods We retrospectively included 59 patients with CCA who underwent surgery and postoperative RT with curative intent from 2004 to 2019. Patients received external irradiation (50 Gy in 25 fractions) using three‐dimensional RT. We analyzed prognostic factors of inflammation, such as pre‐RT platelet count, hemoglobin, lymphocyte count ratio (LCR) of the leukocyte count, platelet‐to‐lymphocyte ratio (PLR), and neutrophil‐to‐lymphocyte ratio (NLR). Results Tumor stages were distributed as follows: I (n = 8), II (n = 25), III (n = 15), and IVA (n = 11). The median follow‐up was 24 months. Two‐year overall survival (OS), cause‐specific survival (CSS), progression‐free survival (PFS), and locoregional control (LRC) rates were 59.5%, 62.0%, 40.1%, and 66.7%, respectively. Univariate analysis revealed that lower LCR was significantly associated with shorter PFS (p = 0.0446). There was no significant difference between the median baseline values of PLR and NLR; and age ≥75, positive regional lymph node metastases (N+), and chemotherapy after RT were significantly associated with poor OS. Multivariate analysis revealed a significant association of N+ with worse OS, PFS, and CSS and that lower LCR was significantly associated with better PFS (p = 0.0234). Among late toxicity events, two patients (3.38%) were suspected with therapy‐related liver toxicity. Conclusions Lower LCR before RT was a better prognostic factor for postoperative RT of patients with CCA. Image‐guided percutaneous pericardial effusion drainage for cancer patients is safe and contributes to the alleviation of symptoms. Additionally, catheter removal is possible in most patients, thereby allowing a catheter‐free period for them.
ISSN:1743-7555
1743-7563
DOI:10.1111/ajco.13809