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Elevated NLR in gallbladder cancer and cholangiocarcinoma - making bad cancers even worse: results from the US Extrahepatic Biliary Malignancy Consortium. HPB (Oxford) 2016 11;18(11):950-957



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Scopus ID

2-s2.0-84992750982   22 Citations


BACKGROUND: Gallbladder and extrahepatic biliary malignancies are aggressive tumors with high risk of recurrence and death. We hypothesize that elevated preoperative Neutrophil-Lymphocyte Ratios (NLR) are associated with poor prognosis among patients undergoing resection of gallbladder or extrahepatic biliary cancers.

METHODS: Patients who underwent complete surgical resection between 2000-2014 were identified from 10 academic centers (n=525). Overall (OS) and recurrence-free survival (RFS) were analyzed by stratifying patients with normal (<5) versus elevated (>5) NLR.

RESULTS: Overall, 375 patients had NLR <5 while 150 patients had NLR >5. Median OS was 24.5 months among patients with NLR<5 versus 17.0 months among patients with NLR>5 (p<0.001). NLR was also associated with OS in subgroup analysis of patients with gallbladder cancer. In fact, on multivariable analysis, NLR>5, dyspnea and preoperative peak bilirubin were independently associated with OS in patients with gallbladder cancer. Median RFS was 26.8 months in patients with NLR<5 versus 22.7 months among patients with NLR>5 (p=0.030). NLR>5 was independently associated with worse RFS for patients with gallbladder cancer.

CONCLUSIONS: Elevated NLR was associated with worse outcomes in patients with gallbladder and extrahepatic biliary cancers after curative-intent resection. NLR is easily measured and may provide important prognostic information.

Author List

Beal EW, Wei L, Ethun CG, Black SM, Dillhoff M, Salem A, Weber SM, Tran T, Poultsides G, Son AY, Hatzaras I, Jin L, Fields RC, Buettner S, Pawlik TM, Scoggins C, Martin RC, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Schmidt CR


Harveshp Mogal MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Bile Duct Neoplasms
Disease-Free Survival
Gallbladder Neoplasms
Kaplan-Meier Estimate
Lymphocyte Count
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Time Factors
Treatment Outcome
United States
jenkins-FCD Prod-468 69a93cef3257f26b866d455c1d2b2d0f28382f14