Albumin to gamma-glutamyltransferase ratio as a prognostic indicator in intrahepatic cholangiocarcinoma after curative resection

// Chu-Yu Jing 1, * , Yi-Peng Fu 1, * , Hu-Jia Shen 1, * , Su-Su Zheng 1 , Jia-Jia Lin 1 , Yong Yi 1 , Jin-Long Huang 1 , Xin Xu 1 , Juan Zhang 1 , Jian Zhou 1 , Jia Fan 1 , Zheng-Gang Ren 1 , Shuang-Jian Qiu 1 , Bo-Heng Zhang 1 1 The Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School, Fudan University, Key Laboratory for Carcinogenesis and Cancer Invasion, The Chinese Ministry of Education, Shanghai, P.R. China. * These authors have contributed equally to this work Correspondence to: Bo-Heng Zhang, email: zhang.boheng@zs-hospital.sh.cn Keywords: albumin, gamma-glutamyltransferase, intrahepatic cholangiocarcinoma, prognosis, nomogram Received: September 06, 2016      Accepted: December 27, 2016      Published: January 05, 2017 ABSTRACT The prognosis of intrahepatic cholangiocarcinoma (ICC) remains poor whereas predictive models for survival prediction in ICC patients following curative resection are limited. Herein, we established a novel inflammation-based score derived from preoperative albumin to gamma-glutamyltransferase ratio (AGR) and evaluated its prognostic significance in ICC patients underwent curative resection. Prognostic value of AGR was retrospectively studied in a cohort comprising 206 ICC patients following curative resection. The predictive performance of AGR was compared with other inflammation-based scores and serological tumor markers in terms of concordance index (C-index). Further, prognostic nomograms incorporating AGR into the tumor-node-metastasis (TNM) staging systems were established to achieve a better discriminatory ability. The optimal cut-off value of AGR was 0.6. Multivariate analysis showed that AGR was an independent predictor for overall survival (OS; P = 0.003) and recurrence-free survival (RFS; P = 0.046). The C-index of AGR was superior to other inflammation-based scores and serological tumor markers in OS and RFS prediction. The established nomograms showed improved predictive accuracy compared with the TNM staging systems alone. These results indicate that AGR is an independent prognostic indicator for ICC underwent curative resection. The incorporation of AGR into the existing TNM staging systems achieved improved predictive accuracy.