Preoperative fibrinogen/albumin combine SII/CA19-9 to predict prognosis for patients with distal cholangiocarcinoma under pancreatoduodenectomy

Background: Distal cholangiocarcinoma (DCC) is known as high malignant potential and poor prognosis. FAR can reflect the inflammatory reaction, coagulation function and nutritional status. CA19-9 has been confirmed to be significantly correlated with the diagnosis, recurrence and long-term prognosis of distal cholangiocarcinoma. SII can reflect the local immune response and systemic inflammation. In this study, SII/CA19-9 and FAR were used to predict recurrence and long-term survival of patients with distal cholangiocarcinoma under pancreatoduodenectomy. Methods: According to the inclusion and exclusion criteria, the data of 238 patients with distal cholangiocarcinoma under pancreatoduodenectomy in Department of hepatobiliary surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University from January 2010 to December 2024 were retrospectively analyzed. Based on the 1-year survival rates, ROC curve was drawn to determine the optimal cut-off value of SII/CA19-9, and the patients were divided into low ratio group (n=106) and high ratio group (n=132). The risk factors of long-term survival were analyzed, and the survival rate was compared according to SII/CA19-9 ratio. Similarly, based on the 1-year survival rates, ROC curve was drawn to determine the optimal cut-off value of FAR. Then the patients were divided into low FAR group (n=86) and high FAR group (n=152), and the risk factors influencing the long-term survival in different groups were further analyzed separately. Results: The best cut-off value of SII/CA19-9 was 8 (area under curve: 0.670, 95% CI: 0.586-0.754). For the overall patient, SII/CA19-9、invasion of portal vein、lymph node metastasis、chemotherapy cycle were independent risk factors for long-term survival. The overall median survival time of patients with SII/CA19-9 low ratio group and high ratio group was 44 months and 17 months, respectively. The 1-year, 3-year and 5-year overall survival rates were 86.3%, 52.1%, 39.5% and 64.1%, 20.0% and 16.6%, respectively (P = 0.000). For patients with low FAR level, invasion of portal veinand lymph node metastasis were independent risk factors for long-term survival. For patients with high FAR level, SII/CA19-9, invasion of portal vein and chemotherapy cycle were independent risk factors for long-term survival. Conclusion: Compared with CA19-9 alone, SII/CA19-9 is more valuable in judging the long-term survival of distal cholangiocarcinoma, especially with FAR level. The higher preoperative SII/CA19-9 ratio is, the lower FAR is, the better long-term prognosis will be.