Cancer Res Treat.  2017 Oct;49(4):1127-1139. 10.4143/crt.2016.538.

Prognostic Factors and Scoring Model for Survival in Metastatic Biliary Tract Cancer

• Park HS
• Park JS
• Chun YJ
• Roh YH
• Moon J
• Chon HJ
• Choi HJ
• Park JS
• Lee DK
• Lee SJ
• Yoon DS
• Jeung HC

• KMID: 2394831
• DOI: http://doi.org/10.4143/crt.2016.538

Abstract

PURPOSE
Metastatic biliary tract cancer (mBTC) has a dismal prognosis. In this study, an independent dataset of patients with mBTC was used to implement and validate a routine clinico-laboratory parameter-based scoring model for risk group identification.
MATERIALS AND METHODS
From September 2006 to February 2015, 482 patients with mBTC were assigned randomly (ratio, 7:3) into investigational (n=340) and validation datasets (n=142). The continuous variables were dichotomized using a normal range or the best cutoff values determined using the Contal and O'Quigley statistical methods. Following a Cox's proportional hazard model, the scoring model was derived by summing the rounded chi-square scores for the factors identified by multivariate analysis.
RESULTS
The performance status (Eastern Cooperative Oncology Group 3-4), hypoalbuminemia (< 3.4 mg/dL), carcinoembryonic antigen (≥ 9 ng/mL), neutrophil-to-lymphocyte ratio (≥ 3.0), and carbohydrate antigen 19-9 (≥ 120 U/mL) were identified as independent prognosticators (Harrell's C index, 0.682; integrated area under the curve, 0.653). Survival was clearly correlated with the risk groups (low, intermediate, and high, 14.0, 7.3, and 2.3 months, respectively; p < 0.001). The prognosis was also discriminative in the validation data set (median survival, 16.7, 7.5, and 1.9 months, respectively; p < 0.001). Chemotherapy did not offer any survival benefits for high-risk patients.
CONCLUSION
These proposed prognostic criteria for mBTC can facilitate accurate patient risk stratification and treatment-related decision-making.

Keyword

Biliary tract neoplasms; Prognosis; Scoring model; Survival; Validation; Drug therapy

MeSH Terms

Biliary Tract Neoplasms*
Biliary Tract*
Carcinoembryonic Antigen
Dataset
Drug Therapy
Humans
Hypoalbuminemia
Multivariate Analysis
Prognosis
Proportional Hazards Models
Reference Values
Social Identification
Carcinoembryonic Antigen

Figure

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  Fig. 1. Consort diagram of the enrolled patients.

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  Fig. 2. Kaplan-Meier curves of overall survival for the investigation dataset (n=340): carcinoembryonic antigen (CEA) (A), carbohydrate antigen 19-9 (CA 19-9) (B), neutrophil-to-lymphocyte ratio (NLR) (C), and platelet-to-lymphocyte ratio (PLR) (D).

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  Fig. 3. Kaplan-Meier curves of overall survival according to the risk groups based on the prognostic prediction scores: low risk, 0-2; intermediate risk, 3-5; and high risk, 6-8; investigation (A) and validation datasets (B).

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  Fig. 4. Kaplan-Meier curves of the overall survival according to palliative chemotherapy use in the investigation and validation datasets: low-intermediate-risk (A, C) and high-risk (B, D), respectively. Gem/Cis, combination chemotherapy with cisplatin and gemcitabine.

Reference

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