A Novel Biomarker-Based Preoperative Prognostic Grading System for Predicting Survival After Surgery for Intrahepatic Cholangiocarcinoma

Ann Surg Oncol. 2017 May;24(5):1351-1357. doi: 10.1245/s10434-016-5708-z. Epub 2017 Jan 20.


Background: Although treatment strategies for intrahepatic cholangiocarcinoma (ICC) are shifting towards multidisciplinary approaches, preoperative radiographic methods for identifying patients requiring further therapy are unclear. This study was designed to establish a prognostic grading system using preoperatively available objective biomarkers.

Methods: A novel preoperative prognostic grading system for predicting survival after surgery for ICC was developed from multivariate analysis of 134 ICC patients who underwent surgery between 1996 and 2015 using preoperatively available biomarkers.

Results: The median overall survival time and 3- and 5 year survival rates were 33.3 months, 48, and 38%, respectively. Of the preoperative biomarkers, the neutrophil-to-lymphocyte ratio (≥5), and C-reactive protein (≥5 mg/L) and carbohydrate antigen 19-9 (≥500 IU/mL) levels were independently associated with poor overall survival. Based on the presence of these factors, the preoperative prognostic grades were defined as follows: grade 1, no factor; grade 2, one factor; and grade 3, two or three factors. The median overall survival time and 3- and 5 year survival rates of patients with grade 1 (70.3 months, 66, and 53%, respectively) were higher than those of patients with grade 2 (23.4 months, 37, and 30%, respectively; P = 0.004) and grade 3 (8.8 months, 5% both; 2 vs. 3, P < 0.001). Multivariable analysis revealed that the preoperative prognostic grading system independently predicted survival after adjusting for known prognostic factors.

Conclusions: A novel biomarker-based preoperative prognostic grading system for ICC significantly stratifies survival after surgery and may identify patients requiring further treatment.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / blood*
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Intrahepatic
  • Biomarkers, Tumor / blood*
  • C-Reactive Protein / metabolism*
  • CA-19-9 Antigen / blood*
  • Cholangiocarcinoma / blood*
  • Cholangiocarcinoma / surgery
  • Female
  • Humans
  • Lymphocyte Count
  • Lymphocytes*
  • Male
  • Middle Aged
  • Neutrophils*
  • Preoperative Period
  • Prognosis
  • Survival Rate


  • Biomarkers, Tumor
  • CA-19-9 Antigen
  • C-Reactive Protein