Autor(es):
Tsilimigras, D ; Hyer, J ; Moris, D ; Sahara, K ; Bagante, F ; Guglielmi, A ; Aldrighetti, L ; Alexandrescu, S ; Pinto Marques, H ; Shen, F ; Koerkamp, B ; Endo, I ; Pawlik, T
Data: 2019
Identificador Persistente: http://hdl.handle.net/10400.17/3660
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Aged; Bile Duct Neoplasms; Bilirubin; Biomarkers; Cholangiocarcinoma; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Serum Albumin; Survival Rate; Treatment Outcome; Bile Ducts, Intrahepatic; Hepatectomy; HCC CIR
Descrição
Background: The objective of the current study was to define the impact of albumin-bilirubin (ALBI) grade on short- as well as long-term outcomes among patients with intrahepatic cholangiocarcinoma (ICC). Methods: Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified using an international multi-institutional database. Clinicopathologic factors including ALBI score were assessed using bivariate and multivariable analyses, as well as standard survival analyses. Results: Among 706 patients, 453 (64.2%) patients had ALBI grade 1, 231 (32.7%) ALBI grade 2, and 22 (3.1%) had ALBI grade 3. After adjusting for all competing factors, patients with ALBI grade 2/3 had higher odds of a prolonged length-of-stay (>10 days, odds ratio [OR] = 2.37, 95% confidence interval [CI]:1.47-3.80), perioperative transfusion (OR = 2.15, 95% CI:1.45-3.18) and 90-day mortality (OR = 2.50, 95% CI:1.16-5.38). Median and 5-year overall survival (OS) for the entire cohort was 41.5 months (IQR:15.7-107.8) and 39.8%, respectively. Of note, median OS incrementally worsened with increased ALBI grade: grade 1, 49.6 months (IQR:18.3-NR) vs grade 2, 29.6 months (IQR:12.6-98.4) vs grade 3, 16.9 months (IQR:6.5-32.4; P < 0.001). On multivariable analysis, higher ALBI grade remained associated with higher hazards of death (grade 2/3: hazard ratio = 1.36, 95% CI:1.04-1.78). Conclusion: The ALBI score was associated with both short- and long-term outcomes following resection for ICC and could prove a useful surrogate marker to identify patients at risk for adverse outcomes.
