The neutrophil-to-lymphocyte ratio before treatment might serve as a useful biomarker for poor prognosis in patients with cholangiocarcinoma (CCA), according to a new study published in Scientific Reports

Since patients with CCA undergoing surgical treatment usually have high rates of morbidity and mortality, it is of great importance to select and stratify patients based on surgical risk and potential oncological benefits. The preoperative neutrophil-to-lymphocyte ratio could serve as an invaluable tool for this selection and facilitate the clinical management of patients.

It is already known that the neutrophil-to-lymphocyte ratio is significantly associated with poor oncological outcomes, and it is used as a prognostic biomarker in different types of cancer. Based on this knowledge, a team of researchers led by Jan Bednarsch, MD, from the Department of Surgery and Transplantation, University Hospital RWTH Aachen in Germany hypothesized that it could also be a prognostic biomarker for reduced overall and disease-free survival rates in patients with CCA.

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To test their hypothesis, the researchers conducted a systematic review of the literature and a meta-analysis from January 2000 to September 2021. They identified 32 studies on 8572 patients related to neutrophil-to-lymphocyte ratio and clinical outcomes in CCA.

Statistical analyses showed that a high neutrophil-to-lymphocyte ratio before treatment was associated with poor overall and disease-free survival rates in CCA. The type of treatment (whether surgical or other), cut-off values, age of the patients, and sample size did not affect these associations.

Based on these findings, the researchers concluded that a high pretreatment neutrophil-to-lymphocyte ratio may be a biomarker for reduced oncological outcomes in patients with CCA.

CCA can either be treated medically or surgically. Whenever possible, surgical resection is the first line of treatment for the disease. Biliary drainage and portal vein embolization may be done before surgery to increase the resectability of the tumor and reduce morbidity and mortality after the operation.


Liu D, Heij LR, Czigany Z, et al. The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis. Sci Rep. 2022;12:12691. doi:10.1038/s41598-022-16727-w