Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma
Tatsuo Matsuda,
Yuzo Umeda,
Tadakazu Matsuda,
Yoshikatsu Endo,
Daisuke Sato,
Toru Kojima,
Kenta Sui,
Masaru Inagaki,
Tetsuya Ota,
Masayoshi Hioki,
Masahiro Oishi,
Masashi Kimura,
Toshihiro Murata,
Nobuhiro Ishido,
Takahito Yagi,
Toshiyoshi Fujiwara
Affiliations
Tatsuo Matsuda
Department of Surgery, Tenwakai Matsuda Hospital
Yuzo Umeda
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Tadakazu Matsuda
Department of Surgery, Tenwakai Matsuda Hospital
Yoshikatsu Endo
Department of Surgery, Japanese Red Cross Himeji Hospital
Daisuke Sato
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Toru Kojima
Department of Surgery, Okayama Saiseikai General Hospital
Kenta Sui
Department of Gastroenterological Surgery, Kochi Health Sciences Center
Masaru Inagaki
Department of Surgery, National Hospital Organization Fukuyama Medical Center
Tetsuya Ota
Department of Surgery, National Hospital Organization Okayama Medical Center
Masayoshi Hioki
Department of Surgery, Fukuyama City Hospital
Masahiro Oishi
Department of Surgery, Tottori Municipal Hospital
Masashi Kimura
Department of Surgery, Matsuyama Shimin Hospital
Toshihiro Murata
Department of Surgery, Onomichi Municipal Hospital
Nobuhiro Ishido
Department of Surgery, Japanese Red Cross Kobe Hospital
Takahito Yagi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Toshiyoshi Fujiwara
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Abstract Background In the surgical treatment of intrahepatic cholangiocarcinoma (ICC), postoperative complications may be predictive of long-term survival. This study aimed to identify an immune-nutritional index (INI) that can be used for preoperative prediction of complications. Patients and methods Multi-institutional data from 316 patients with ICC who had undergone surgical resection were retrospectively analysed, with a focus on various preoperative INIs. Results Severe complications (Clavien-Dindo grade III–V) were identified in 66 patients (20.8%), including Grade V complications in 7 patients (2.2%). Comparison of areas under the receiver operating characteristic curve (AUCs) among various INIs identified the prognostic nutritional index (PNI) as offering the highest predictive value for severe complications (AUC = 0.609, cut-off = 50, P = 0.008). Multivariate analysis revealed PNI < 50 (odds ratio [OR] = 2.22, P = 0.013), hilar lesion (OR = 2.46, P = 0.026), and long operation time (OR = 1.003, P = 0.029) as independent risk factors for severe complications. In comparing a high-PNI group (PNI ≥ 50, n = 142) and a low-PNI group (PNI < 50, n = 174), the low-PNI group showed higher rates of both major complications (27% vs. 13.4%; P = 0.003) and infectious complications (14.9% vs. 3.5%; P = 0.0021). Furthermore, median survival time and 1- and 5-year overall survival rates were 34.2 months and 77.4 and 33.8% in the low-PNI group, respectively, and 52.4 months and 89.3 and 47.5% in the high-PNI group, respectively (P = 0.0017). Conclusion Preoperative PNI appears useful as an INI correlating with postoperative severe complications and as a prognostic indicator for ICC.
