N. SAITO1, Y. Shirai1, T. Horiuchi1, H. Sugano1, R. Iwase1, K. Haruki1, Y. Fujiwara1, K. Furukawa1, H. Shiba1, T. Uwagawa1, T. Ohashi2, K. Yanaga1 1The Jikei University School of Medicine,Department of Surgery,Minato-ku, TOKYO, Japan 2The Jikei University School of Medicine,Division Of Gene Therapy, Research Center For Medical Sciences,Minato-ku, TOKYO, Japan
Introduction: Several studies on bile duct carcinoma have investigated systematic inflammation-based preoperative prognostic indicators such as platelets, albmin and inflammatory mediators. Since inflammation is associated with prognosis, we hypothesized that the Platelet-to-Albmin Ratio (PAR), a novel inflammation-based prognostic score, is associated with long-term survival in patients with bile duct carcinoma after hepatic or pancreatic resection. The aim of this study is to evaluate a prognostic value of preoperative PAR in bile duct carcinoma.?
Methods: A total of 59 patients who underwent pancreatic resection for bile duct carcinoma were studied. The patients were divided into two groups as PAR ≥ 72.6 x 103 or < 72.6 x 103 on the basis of ROC curve analysis (2-year survival, AUC=0.709 ± 0.08, p=0.002). Survival data were analyzed using the Log-rank test for univariate analysis. Multivariate analysis was performed by Cox proportional regression model with backward elimination stepwise approach.
Results: The PAR was a significant prognostic index on univariate analysis for DFS and OS. The PAR also retained its significance on multivariate analysis for DFS (HR 4.422, 95%CI 1.168 – 16.732, p=0.029) and for OS (HR 6.232, 95%CI 1.283-30.279, p=0.023). On multivariate analysis, in addition, tumor differentiation (HR 2.711, 95%CI 1.279 – 5.747, p=0.009) was an independent risk factor for DFS. For OS, along with PAR, tumor differentiation (HR 3.238, 95%CI 1.349 – 7.771, p=0.009), intraoperative blood loss (HR 1.001, 95%CI 1.000 – 1.002, p=0.036) and serum CEA (HR 6.051, 95%CI 1.484 – 24.669, p=0.041) were independent risk factors by multivariate analysis.
Conclusion: The preoperative PAR is a novel and significant independent prognostic index for DFS and OS in patients with bile duct carcinoma after pancreatic resection.