High inflammatory markers correlate with worse outcomes in patients with intrahepatic cholangiocarcinoma (CCA), so a systemic inflammation score could aid in making treatment decisions in patients receiving chemotherapy, according to a recently published study in the Journal of Cancer Research and Clinical Oncology.

Although surgical resection is the standard of care for patients with intrahepatic CCA, the majority of patients are treated with palliative systemic chemotherapy due to advanced disease at the time of diagnosis.

After the failure of the standard-of-care chemotherapy with gemcitabine and cisplatin, options include targeted treatment based on distinct molecular alterations and chemotherapy with fluoropyrimidine. However, the median overall survival for these patients does not surpass 13 months. 


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Although systemic inflammatory response parameters (SIR) have been successfully used as prognostic markers in other malignancies, their value in guiding treatment decisions in patients receiving chemotherapy for intrahepatic CCA remained unknown.

The authors aimed to retrospectively assess the correlation of systemic inflammatory response markers in a cohort including over 200 patients with intrahepatic CCA receiving palliative systemic chemotherapy. Inflammatory markers such as a neutrophile-to-lymphocyte ratio and C-reactive protein were correlated with clinical and pathological findings and with survival rates. The statistical analysis was carried out using Kaplan-Meier analysis and Cox proportional models.

The median overall survival of the cohort was approximately 15 months. The population included 119 patients who had received standard-of-care chemotherapy as palliative or due to recurrence after resection; 59 patients received more than 1 line of chemotherapy.

Only 58 patients had available systemic inflammatory responses. This group was subdivided based on the number of positive systemic inflammatory response parameters into low systemic inflammation, intermediate systemic inflammation, and high systemic inflammation. 

There were significant differences in overall survival between the 2 groups, each with 28 months, 14 months, and 6 months, respectively. Similarly, patients with low systemic inflammation were more likely to respond to first-line therapy than patients with intermediate or high systemic inflammation. 

“The [systemic inflammation score] allows the assignment of patients into low- and high-risk groups, which could be a support for therapeutic decision or a future stratification factor for clinical trials,” the authors concluded.

Reference

Maßmann, M, Treckmann J, Markus P, et al. A prognostic systemic inflammation score (SIS) in patients with advanced intrahepatic cholangiocarcinoma. J Cancer Res Clin Oncol. Published online November 5, 2022. doi:10.1007/s00432-022-04424-0