Risk factors for occult metastasis detected by inflammation-based prognostic scores and tumor markers in biliary tract cancer

doi:10.12998/wjcc.v9.i32.9770

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World Journal of Clinical Cases

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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.

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

ARTICLE HIGHLIGHTS

Research background

Advances in radiological imaging techniques have enabled us to understand the details of biliary tract cancer (BTC) preoperatively. However, detecting small liver metastasis or peritoneal metastasis remains difficult in BTCs.

Research motivation

Staging laparoscopy may help avoid unnecessary laparotomy due to the occult metastases. However, there are no standard methods for selecting staging laparoscopy in BTC.

Research objectives

This study aimed to elucidate the risk factors for exploratory laparotomy due to occult metastasis in patients with BTC using tumor markers and inflammation-based prognostic scores.

Research methods

This was a retrospective study from the data of 236 BTC patients.

Research results

Twenty-six (11%) patients underwent exploratory laparotomy, and there were sixteen occult metastasis cases (7 liver metastasis and 9 abdominal disseminations). Serum carcinoembryonic antigen, carbohydrate antigen 19-9, neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the exploratory laparotomy group (n = 26) than in the resected group (n = 210). Among these factors, carcinoembryonic antigen > 7 ng/mL was the most useful to predict occult metastasis. When patients had more than three of these positive factors, the rate of occult metastasis increased.

Research conclusions

Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in patients with BTC, and based on a combination of these factors, selective staging laparoscopy may reduce the rate of exploratory laparotomy.

Research perspectives

Since BTCs are heterogeneous malignancies, a study with a large number of tumors is required.