Prognostic significance of the cachexia index for patients with perihilar cholangiocarcinoma

Background: The prognostic value of the preoperative cachexia index for patients with perihilar cholangiocarcinoma remains unclear. Methods: We retrospectively evaluated 236 patients who underwent radical resection for perihilar cholangiocarcinoma from September 2002 to December 2020. The cachexia index was calculated as follows: (skeletal muscle index x albumin level)/neutrophil-to-lymphocyte ratio, with sex-specific cutoff values determined via receiver operating characteristic curves on the basis of 3-year survival data. Clinicopathologic characteristics and survival outcomes were compared between the low-cachexia index (n = 95) and high-cachexia index (n = 141) groups. Multivariable analyses were performed to identify prognostic factors for overall survival and relapse-free survival. Results: The low-cachexia index group was characterized by greater carbohydrate antigen 19e9 level (56 vs 31 U/mL, P = .024) and greater proportion of preoperative biliary drainage (84% vs 70%, P = .013). The low-cachexia index group underwent vascular resection and reconstruction more frequently (47% vs 29%, P = .006) and had a greater rate of lymph node metastasis (54% vs 35%, P = .005). The median overall survival and relapse-free survival times of the low-cachexia index group were significantly worse than those of the high-cachexia index group (overall survival, 29.0 vs 47.4 months, P < .001; relapse-free survival, 17.2 vs 33.1 months, P < .001). Multivariable analysis revealed that a preoperative cachexia index (hazard ratio for overall survival, 0.95, P = .008; hazard ratio for relapse-free survival, 0.95, P = .017) and high preoperative carbohydrate antigen 19-9 level (hazard ratio for overall survival, 1.01, P = .002; hazard ratio for relapse-free survival, 1.01, P = .012) were prognostic factors. Conclusion: The cachexia index may be a useful biomarker for the prediction of tumor aggressiveness and prognosis before perihilar cholangiocarcinoma resection. (c) 2025 Published by Elsevier Inc.