Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium
Abstract Background Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or ex...
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| creator | Beal, Eliza W Wei, Lai Ethun, Cecilia G Black, Sylvester M Dillhoff, Mary Salem, Ahmed Weber, Sharon M Tran, Thuy Poultsides, George Son, Andre Y Hatzaras, Ioannis Jin, Linda Fields, Ryan C Buettner, Stefan Pawlik, Timothy M Scoggins, Charles Martin, Robert C.G Isom, Chelsea A Idrees, Kamron Mogal, Harveshp D Shen, Perry Maithel, Shishir K Schmidt, Carl R |
| description | Abstract Background Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. Methods Patients who underwent complete surgical resection between 2000–2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (5) NLR. Results Overall, 375 patients had NLR 5. Median OS was 24.5 months among patients with NLR5 (p5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. Conclusions Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information. |
| doi_str_mv | 10.1016/j.hpb.2016.08.006 |
| format | Article |
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We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. Methods Patients who underwent complete surgical resection between 2000–2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR. Results Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. Conclusions Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.</description><identifier>ISSN: 1365-182X</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1016/j.hpb.2016.08.006</identifier><identifier>PMID: 27683047</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Academic Medical Centers ; Aged ; Bile Duct Neoplasms - blood ; Bile Duct Neoplasms - mortality ; Bile Duct Neoplasms - pathology ; Bile Duct Neoplasms - surgery ; Cholangiocarcinoma - blood ; Cholangiocarcinoma - mortality ; Cholangiocarcinoma - pathology ; Cholangiocarcinoma - surgery ; Disease-Free Survival ; Female ; Gallbladder Neoplasms - blood ; Gallbladder Neoplasms - mortality ; Gallbladder Neoplasms - pathology ; Gallbladder Neoplasms - surgery ; Gastroenterology and Hepatology ; Humans ; Kaplan-Meier Estimate ; Lymphocyte Count ; Lymphocytes ; Male ; Middle Aged ; Neutrophils ; Original ; Predictive Value of Tests ; Proportional Hazards Models ; Risk Factors ; Time Factors ; Treatment Outcome ; United States</subject><ispartof>HPB (Oxford, England), 2016-11, Vol.18 (11), p.950-957</ispartof><rights>International Hepato-Pancreato-Biliary Association Inc.</rights><rights>2016 International Hepato-Pancreato-Biliary Association Inc.</rights><rights>Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.</rights><rights>2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved. 2016 International Hepato-Pancreato-Biliary Association Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c572t-c8a932f3f417fc9734c9d62ad02a8d58008e8e3db3caaec39cee85a86a2a6ba53</citedby><cites>FETCH-LOGICAL-c572t-c8a932f3f417fc9734c9d62ad02a8d58008e8e3db3caaec39cee85a86a2a6ba53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094484/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094484/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27925,27926,53792,53794</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27683047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beal, Eliza W</creatorcontrib><creatorcontrib>Wei, Lai</creatorcontrib><creatorcontrib>Ethun, Cecilia G</creatorcontrib><creatorcontrib>Black, Sylvester M</creatorcontrib><creatorcontrib>Dillhoff, Mary</creatorcontrib><creatorcontrib>Salem, Ahmed</creatorcontrib><creatorcontrib>Weber, Sharon M</creatorcontrib><creatorcontrib>Tran, Thuy</creatorcontrib><creatorcontrib>Poultsides, George</creatorcontrib><creatorcontrib>Son, Andre Y</creatorcontrib><creatorcontrib>Hatzaras, Ioannis</creatorcontrib><creatorcontrib>Jin, Linda</creatorcontrib><creatorcontrib>Fields, Ryan C</creatorcontrib><creatorcontrib>Buettner, Stefan</creatorcontrib><creatorcontrib>Pawlik, Timothy M</creatorcontrib><creatorcontrib>Scoggins, Charles</creatorcontrib><creatorcontrib>Martin, Robert C.G</creatorcontrib><creatorcontrib>Isom, Chelsea A</creatorcontrib><creatorcontrib>Idrees, Kamron</creatorcontrib><creatorcontrib>Mogal, Harveshp D</creatorcontrib><creatorcontrib>Shen, Perry</creatorcontrib><creatorcontrib>Maithel, Shishir K</creatorcontrib><creatorcontrib>Schmidt, Carl R</creatorcontrib><title>Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>Abstract Background Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. Methods Patients who underwent complete surgical resection between 2000–2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR. Results Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. Conclusions Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Bile Duct Neoplasms - blood</subject><subject>Bile Duct Neoplasms - mortality</subject><subject>Bile Duct Neoplasms - pathology</subject><subject>Bile Duct Neoplasms - surgery</subject><subject>Cholangiocarcinoma - blood</subject><subject>Cholangiocarcinoma - mortality</subject><subject>Cholangiocarcinoma - pathology</subject><subject>Cholangiocarcinoma - surgery</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Gallbladder Neoplasms - blood</subject><subject>Gallbladder Neoplasms - mortality</subject><subject>Gallbladder Neoplasms - pathology</subject><subject>Gallbladder Neoplasms - surgery</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphocyte Count</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neutrophils</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1365-182X</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsuOEzEQHCEQuyx8ABfkI5cEezwPD0grQZQFpAASy0rcrB67J3HWYwd7JpDb_gNH_o4vwVHCCjhw6pZcVS5VdZY9ZnTKKKueraerTTvN0zqlYkppdSc7ZUVdT_KyLu6mnVflhIn880n2IMY1pXmiNfezk7yuBKdFfZr9mFvcwoCavF98JMaRJVjbWtAaA1HgVBrgNFErb8EtjVcQlHG-B_Lz5jvp4dq4JWlBH8GR4BYd-epDxOckYBztEEkXfE-GFZKrSzL_NgRY4QYGo8grYw2EHXkH1ixdUtiRmXfRh8GM_cPsXgc24qPjPMuuLuafZm8miw-v385eLiaqrPNhogQ0PO94V7C6U03NC9XoKgdNcxC6FJQKFMh1yxUAKt4oRFGCqCCHqoWSn2XnB93N2PaoFbrk0MpNMH3yJj0Y-feLMyu59FtZ0qYoRJEEnh4Fgv8yYhxkb6JCmxJDP0bJBK85bWpaJyg7QFXwMQbsbr9hVO5LlWuZSpX7UiUVMpWaOE_-9HfL-N1iArw4ADCltDUYZFQGUx3aBFSD1N78V_78H7ayxhkF9hp3GNd-DC7FL5mMuaTycn9V-6NiFWeiEoL_AgDLzQA</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Beal, Eliza W</creator><creator>Wei, Lai</creator><creator>Ethun, Cecilia G</creator><creator>Black, Sylvester M</creator><creator>Dillhoff, Mary</creator><creator>Salem, Ahmed</creator><creator>Weber, Sharon M</creator><creator>Tran, Thuy</creator><creator>Poultsides, George</creator><creator>Son, Andre Y</creator><creator>Hatzaras, Ioannis</creator><creator>Jin, Linda</creator><creator>Fields, Ryan C</creator><creator>Buettner, Stefan</creator><creator>Pawlik, Timothy M</creator><creator>Scoggins, Charles</creator><creator>Martin, Robert C.G</creator><creator>Isom, Chelsea A</creator><creator>Idrees, Kamron</creator><creator>Mogal, Harveshp D</creator><creator>Shen, Perry</creator><creator>Maithel, Shishir K</creator><creator>Schmidt, Carl R</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161101</creationdate><title>Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium</title><author>Beal, Eliza W ; Wei, Lai ; Ethun, Cecilia G ; Black, Sylvester M ; Dillhoff, Mary ; Salem, Ahmed ; Weber, Sharon M ; Tran, Thuy ; Poultsides, George ; Son, Andre Y ; Hatzaras, Ioannis ; Jin, Linda ; Fields, Ryan C ; Buettner, Stefan ; Pawlik, Timothy M ; Scoggins, Charles ; Martin, Robert C.G ; Isom, Chelsea A ; Idrees, Kamron ; Mogal, Harveshp D ; Shen, Perry ; Maithel, Shishir K ; Schmidt, Carl R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c572t-c8a932f3f417fc9734c9d62ad02a8d58008e8e3db3caaec39cee85a86a2a6ba53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Bile Duct Neoplasms - blood</topic><topic>Bile Duct Neoplasms - mortality</topic><topic>Bile Duct Neoplasms - pathology</topic><topic>Bile Duct Neoplasms - surgery</topic><topic>Cholangiocarcinoma - blood</topic><topic>Cholangiocarcinoma - mortality</topic><topic>Cholangiocarcinoma - pathology</topic><topic>Cholangiocarcinoma - surgery</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Gallbladder Neoplasms - blood</topic><topic>Gallbladder Neoplasms - mortality</topic><topic>Gallbladder Neoplasms - pathology</topic><topic>Gallbladder Neoplasms - surgery</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphocyte Count</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neutrophils</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beal, Eliza W</creatorcontrib><creatorcontrib>Wei, Lai</creatorcontrib><creatorcontrib>Ethun, Cecilia G</creatorcontrib><creatorcontrib>Black, Sylvester M</creatorcontrib><creatorcontrib>Dillhoff, Mary</creatorcontrib><creatorcontrib>Salem, Ahmed</creatorcontrib><creatorcontrib>Weber, Sharon M</creatorcontrib><creatorcontrib>Tran, Thuy</creatorcontrib><creatorcontrib>Poultsides, George</creatorcontrib><creatorcontrib>Son, Andre Y</creatorcontrib><creatorcontrib>Hatzaras, Ioannis</creatorcontrib><creatorcontrib>Jin, Linda</creatorcontrib><creatorcontrib>Fields, Ryan C</creatorcontrib><creatorcontrib>Buettner, Stefan</creatorcontrib><creatorcontrib>Pawlik, Timothy M</creatorcontrib><creatorcontrib>Scoggins, Charles</creatorcontrib><creatorcontrib>Martin, Robert C.G</creatorcontrib><creatorcontrib>Isom, Chelsea A</creatorcontrib><creatorcontrib>Idrees, Kamron</creatorcontrib><creatorcontrib>Mogal, Harveshp D</creatorcontrib><creatorcontrib>Shen, Perry</creatorcontrib><creatorcontrib>Maithel, Shishir K</creatorcontrib><creatorcontrib>Schmidt, Carl R</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beal, Eliza W</au><au>Wei, Lai</au><au>Ethun, Cecilia G</au><au>Black, Sylvester M</au><au>Dillhoff, Mary</au><au>Salem, Ahmed</au><au>Weber, Sharon M</au><au>Tran, Thuy</au><au>Poultsides, George</au><au>Son, Andre Y</au><au>Hatzaras, Ioannis</au><au>Jin, Linda</au><au>Fields, Ryan C</au><au>Buettner, Stefan</au><au>Pawlik, Timothy M</au><au>Scoggins, Charles</au><au>Martin, Robert C.G</au><au>Isom, Chelsea A</au><au>Idrees, Kamron</au><au>Mogal, Harveshp D</au><au>Shen, Perry</au><au>Maithel, Shishir K</au><au>Schmidt, Carl R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>18</volume><issue>11</issue><spage>950</spage><epage>957</epage><pages>950-957</pages><issn>1365-182X</issn><eissn>1477-2574</eissn><abstract>Abstract Background Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers. Methods Patients who underwent complete surgical resection between 2000–2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR. Results Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer. Conclusions Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27683047</pmid><doi>10.1016/j.hpb.2016.08.006</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Academic Medical Centers Aged Bile Duct Neoplasms - blood Bile Duct Neoplasms - mortality Bile Duct Neoplasms - pathology Bile Duct Neoplasms - surgery Cholangiocarcinoma - blood Cholangiocarcinoma - mortality Cholangiocarcinoma - pathology Cholangiocarcinoma - surgery Disease-Free Survival Female Gallbladder Neoplasms - blood Gallbladder Neoplasms - mortality Gallbladder Neoplasms - pathology Gallbladder Neoplasms - surgery Gastroenterology and Hepatology Humans Kaplan-Meier Estimate Lymphocyte Count Lymphocytes Male Middle Aged Neutrophils Original Predictive Value of Tests Proportional Hazards Models Risk Factors Time Factors Treatment Outcome United States |
| title | Elevated NLR in gallbladder cancer and cholangiocarcinoma – making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium |
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