Supplementary Material for: Prognostic impact of inflammation-based scores for extrahepatic cholangiocarcinoma

Introduction: Although the relationship between systemic inflammatory responses and prognosis has been known in various cancers, it remains unclear which scores are most valuable for determining the prognosis of extrahepatic cholangiocarcinoma. We aimed to verify the usefulness of various inflammation-based scores as prognostic factors in patients with resected extrahepatic cholangiocarcinoma. Methods: We analyzed consecutive patients undergoing surgical resection for extrahepatic cholangiocarcinoma at our institution between January 2000 and December 2019. The usefulness of the following inflammation-based scores as prognostic factor was investigated: Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI), C-reactive protein to albumin ratio (CAR), controlling nutritional status (CONUT), and prognostic index (PI). Results: A total of 169 patients were enrolled in this study. Of the nine scores, CAR and CONUT indicated prognostic value. Furthermore, multivariate analysis for overall survival revealed that high CAR (>0.23) was an independent prognostic factor (HR: 1.816, 95%CI: 1.135-2.906, p=0.0129), along with lymph node metastasis and curability. There was no difference in tumor staging and short-term outcomes between the low CAR (≤ 0.23) and high CAR groups. Conclusions: CAR was the most valuable prognostic score in patients with resected extrahepatic cholangiocarcinoma.引言：尽管全身炎症反应与预后的关联已在多种癌症中得到证实，但目前仍不明确哪项评分对肝外胆管癌（extrahepatic cholangiocarcinoma）的预后判断最具价值。本研究旨在验证多种基于炎症的评分作为接受根治性切除术的肝外胆管癌患者预后因子的临床效用。方法：本研究分析了2000年1月至2019年12月于本机构接受肝外胆管癌外科切除术的连续性病例，并探究下述炎症相关评分作为预后因子的价值：格拉斯哥预后评分（Glasgow prognostic score, GPS）、修正格拉斯哥预后评分（modified Glasgow prognostic score, mGPS）、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio, NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio, PLR）、淋巴细胞与单核细胞比值（lymphocyte to monocyte ratio, LMR）、预后营养指数（prognostic nutrition index, PNI）、C反应蛋白与白蛋白比值（C-reactive protein to albumin ratio, CAR）、控制营养状况评分（controlling nutritional status, CONUT）及预后指数（prognostic index, PI）。结果：本研究共纳入169例患者。在上述9项评分中，CAR与CONUT展现出显著的预后价值。进一步针对总生存期的多因素回归分析显示，高CAR（>0.23）是独立预后风险因子（风险比HR=1.816，95%置信区间CI：1.135~2.906，P=0.0129），同时淋巴结转移及手术根治性程度亦是独立预后因子。低CAR组（≤0.23）与高CAR组患者在肿瘤分期及短期临床结局方面无统计学差异。结论：在接受根治性切除术的肝外胆管癌患者中，CAR是预后价值最高的炎症相关评分指标。