Combined Serum ALBUMIN with Neutrophil-to-Lymphocyte Ratio Predicts the Prognosis of Biliary Tract Cancer after Curative Resection

SIMPLE SUMMARY: More than 60% of biliary tract cancer patients receive curative surgical resection. Nethereless, there is an absence of useful tools to predict prognosis before operation. Serum albumin and neutrophil-to-lymphocyte ratios are easily determined. Serum albumin is a marker of nutrition status and is correlated with prognosis in many cancer treatments. A neutrophil-to-lymphocyte ratio is a novel parameter widely used in most medical fields because it is a reliable marker of the immune response to different stimuli. Our study demonstrates that combined albumin and neutrophil scores, including nutritional and inflammatory indices, could predict operative survival in resectable biliary tract cancer patients. ABSTRACT: Background: The mainstay treatment of biliary tract cancer is complete tumor resection. Prior to surgery, risk stratification may help to predict and plan treatment approaches. In this study, we investigated the possibility of combining serum albumin concentrations and neutrophil-to-lymphocyte ratios (NLR) to create a score as ANS to predict the prognoses of biliary tract cancer before surgery. Methods: This study retrospectively collected serum albumin concentration, neutrophil, and lymphocyte data measured in biliary tract cancer patients slated to receive complete tumor resections within two weeks before surgery. From January 2013 to December 2019, 268 biliary tract cancer patients who had received tumor resections at our hospital were categorized into 3 ANS groups: ANS = 0 (high albumin and low NLR), ANS = 1 (low albumin or high NLR), and ANS = 2 (low albumin and high NLR). Results: Five-year survival rates were 70.1%, 47.6%, and 30.8% in the ANS = 0, 1, and 2 groups, respectively. The median overall survival time for the ANS = 0 group could not be determined by the end of the study, while those for ANS = 1 and ANS = 2 groups were 54.90 months and 16.62 months, respectively. The results of our multivariate analysis revealed that ANS could be used as an independent predictor of overall and recurrent-free survival. A high ANS was also correlated with other poor prognostic factors. Conclusions: The ANS devised for this study can be used to predict postoperative survival in patients with BTC and to guide treatment strategies.