Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9770-9782
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9770
Risk factors for occult metastasis detected by inflammation-based prognostic scores and tumor markers in biliary tract cancer
Yu Hashimoto, Tetsuo Ajiki, Hiroaki Yanagimoto, Daisuke Tsugawa, Kenta Shinozaki, Hirochika Toyama, Masahiro Kido, Takumi Fukumoto
Yu Hashimoto, Tetsuo Ajiki, Hiroaki Yanagimoto, Daisuke Tsugawa, Kenta Shinozaki, Hirochika Toyama, Masahiro Kido, Takumi Fukumoto, Department of Surgery, Division of Hepato-Biliary-Pancreatic SurgeryKobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
Author contributions: Ajiki T and Hashimoto Y designed and performed the research and wrote the paper; Yanagimoto H and Tsugawa D contributed to the analysis; Shinozaki K collected the clinical data; Toyama H and Kido M provided clinical advice; Fukumoto T supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kobe University Graduate School of Medicine (#160163).
Informed consent statement: Informed consent was obtained using the opt-out principle. For full disclosure, the details of the study are published on the home page of Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tetsuo Ajiki, MD, Professor, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. ajiki@med.kobe-u.ac.jp
Received: May 25, 2021
Peer-review started: May 25, 2021
First decision: July 3, 2021
Revised: July 13, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 16, 2021
Processing time: 169 Days and 0.2 Hours
Abstract
BACKGROUND

Radiological detection of small liver metastasis or peritoneal metastasis is still difficult, and some patients with biliary tract cancer (BTC) are unresectable after laparotomy. Staging laparoscopy may help avoid unnecessary laparotomy. However, which category of BTC is amenable with staging laparoscopy remains unclear.

AIM

To clarify the risk factors for occult metastasis in patients with BTC.

METHODS

Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively reviewed. The patients were divided into two groups, according to resection or exploratory laparotomy (EL). Preoperative laboratory data, including inflammation-based prognostic scores and tumor markers, were compared between the two groups. Prognostic importance of detected risk factors was also evaluated.

RESULTS

A total of 236 patients were enrolled in this study. Twenty-six (11%) patients underwent EL. Among the EL patients, there were 16 cases of occult metastasis (7 liver metastases and 9 abdominal disseminations). Serum carcinoembryonic antigen level, carbohydrate antigen 19-9 level, neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group, and these factors were prognostic. Among these factors, carcinoembryonic antigen > 7 ng/mL was the most useful to predict occult metastasis in BTC. When patients have more than three of these positive factors, the rate of occult metastasis increases.

CONCLUSION

Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC; based on these factors, staging laparoscopy may reduce the rate of EL.

Keywords: Biliary tract cancer; Staging laparoscopy; Neutrophil-lymphocyte ratio; Modified Glasgow prognostic score; Carbohydrate antigen 19-9; Carcinoembryonic antigen

Core Tip: This is a retrospective study to clarify the risk factors for occult metastasis in patients with biliary tract cancer (BTC). Radiological detection of small liver metastasis or peritoneal metastasis is difficult, and 11% BTC patients resulted in exploratory laparotomy in 7 years. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 levels, neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the exploratory laparotomy group than in resected group. In these, CEA > 7 ng/mL and a combination of these factors were useful for predicting occult metastasis in BTC. Based on these factors, selective staging laparoscopy may reduce the rate of exploratory laparotomy.