TY - JOUR
T1 - Albumin-Bilirubin Grade and Tumor Burden Score Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma After Hepatic Resection
T2 - a Multi-Institutional Analysis
AU - Munir, Muhammad Musaab
AU - Endo, Yutaka
AU - Lima, Henrique A.
AU - Alaimo, Laura
AU - Moazzam, Zorays
AU - Shaikh, Chanza
AU - Poultsides, George A.
AU - Guglielmi, Alfredo
AU - Aldrighetti, Luca
AU - Weiss, Matthew
AU - Bauer, Todd W.
AU - Alexandrescu, Sorin
AU - Kitago, Minoru
AU - Maithel, Shishir K.
AU - Marques, Hugo P.
AU - Martel, Guillaume
AU - Pulitano, Carlo
AU - Shen, Feng
AU - Cauchy, François
AU - Koerkamp, Bas Groot
AU - Endo, Itaru
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2023, The Society for Surgery of the Alimentary Tract.
PY - 2023/3
Y1 - 2023/3
N2 - Background: The prognostic role of tumor burden score (TBS) relative to albumin-bilirubin (ALBI) grade among patients undergoing curative-intent resection of ICC has not been examined. Methods: We identified patients who underwent curative-intent resection for ICC between 1990 and 2017 from a multi-institutional database. Multivariable analysis was performed to assess the effect of TBS relative to ALBI grade on both short- and long-term outcomes. Results: Among 724 patients, 360 (49.7%) patients had low TBS and low ALBI grade, 142 (19.6%) patients had low TBS and high ALBI grade, 138 (19.1%) patients had high TBS and low ALBI grade, and 84 patients (11.6%) had high TBS and high ALBI grade. Decreased tumor burden was associated with better long-term outcomes among patients with both low (5-year OS; low TBS vs. high TBS: 52.4% vs 21.4%; p < 0.001) and high ALBI grade (5-year OS; low TBS vs. high TBS: 40.7% vs 12.0%; p < 0.001). On multivariable analysis, higher ALBI grade was associated with greater odds of an extended hospital LOS (> 10 days) (OR 2.80, 95%CI 1.62–4.82; p < 0.001), perioperative transfusion (OR 2.04, 95%CI 1.25–3.36; p = 0.005), 90-day mortality (OR 2.56, 95%CI 1.12–5.81; p = 0.025), as well as a major complication (OR 1.99, 95%CI 1.13–3.49; p = 0.016) among patients with similar tumor burden. Of note, patients with high TBS and high ALBI grade had markedly worse overall survival compared with patients who had low TBS and low ALBI grade disease (HR 2.27; 95%CI 1.44–3.59; p < 0.001). Importantly, high TBS and high ALBI grade were strongly associated with both early recurrence (88.1%%) and 5-year risk of death (96.4%). Conclusion: Both TBS (i.e., tumor morphology) and ALBI grade (i.e., hepatic function reserve) were strong predictors of outcomes among patients undergoing ICC resection. There was an interplay between TBS and ALBI grade relative to patient prognosis after hepatic resection of ICC with high ALBI grade predicting worse outcomes among ICC patients with different TBS.
AB - Background: The prognostic role of tumor burden score (TBS) relative to albumin-bilirubin (ALBI) grade among patients undergoing curative-intent resection of ICC has not been examined. Methods: We identified patients who underwent curative-intent resection for ICC between 1990 and 2017 from a multi-institutional database. Multivariable analysis was performed to assess the effect of TBS relative to ALBI grade on both short- and long-term outcomes. Results: Among 724 patients, 360 (49.7%) patients had low TBS and low ALBI grade, 142 (19.6%) patients had low TBS and high ALBI grade, 138 (19.1%) patients had high TBS and low ALBI grade, and 84 patients (11.6%) had high TBS and high ALBI grade. Decreased tumor burden was associated with better long-term outcomes among patients with both low (5-year OS; low TBS vs. high TBS: 52.4% vs 21.4%; p < 0.001) and high ALBI grade (5-year OS; low TBS vs. high TBS: 40.7% vs 12.0%; p < 0.001). On multivariable analysis, higher ALBI grade was associated with greater odds of an extended hospital LOS (> 10 days) (OR 2.80, 95%CI 1.62–4.82; p < 0.001), perioperative transfusion (OR 2.04, 95%CI 1.25–3.36; p = 0.005), 90-day mortality (OR 2.56, 95%CI 1.12–5.81; p = 0.025), as well as a major complication (OR 1.99, 95%CI 1.13–3.49; p = 0.016) among patients with similar tumor burden. Of note, patients with high TBS and high ALBI grade had markedly worse overall survival compared with patients who had low TBS and low ALBI grade disease (HR 2.27; 95%CI 1.44–3.59; p < 0.001). Importantly, high TBS and high ALBI grade were strongly associated with both early recurrence (88.1%%) and 5-year risk of death (96.4%). Conclusion: Both TBS (i.e., tumor morphology) and ALBI grade (i.e., hepatic function reserve) were strong predictors of outcomes among patients undergoing ICC resection. There was an interplay between TBS and ALBI grade relative to patient prognosis after hepatic resection of ICC with high ALBI grade predicting worse outcomes among ICC patients with different TBS.
KW - Albumin-bilirubin grade
KW - Intrahepatic cholangiocarcinoma
KW - Overall survival
KW - Tumor burden
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U2 - 10.1007/s11605-023-05578-z
DO - 10.1007/s11605-023-05578-z
M3 - Article
C2 - 36652178
AN - SCOPUS:85146538699
SN - 1091-255X
VL - 27
SP - 544
EP - 554
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 3
ER -