Incorporating the lymphocyte-C-reactive protein ratio into risk stratification for intrahepatic cholangiocarcinoma

Objectives To evaluate the prognostic role of the lymphocyte-C-reactive protein ratio (LCR) in intrahepatic cholangiocarcinoma (ICC) within the TNM framework.Methods This study enrolled 248 resected ICC patients (low-LCR: 122; high-LCR: 126). A modified TNM (mTNM)system incorporating LCR was proposed.Results Low LCR was an independent prognostic factor for both overall survival (OS) and recurrence-free survival (RFS) by multivariable analysis. Median OS and RFS times were 43.2 and 12.8 months. Patients were stratified into 5 subgroups according to the mTNM staging system: group 1 (n = 67): stage I, LCR > 6000, group 2 (n = 50): stage I, LCR ≤ 6000, group 3 (n = 49): stage II, LCR > 6000, group 4 (n= 49): stage II, LCR ≤ 6000, and group 5 (n = 33): stage III with any LCR. Survival overlaps occurred between groups 2 and 3 (median OS: 49.4 vs 36.6 months; median RFS: 16.2 vs 13.8 months, p > 0.05). Similar overlaps were found for groups 4 and 5. The mTNM system showed improved discriminative ability (AUC: 0.69) over other staging systems (AUC: 0.63–0.65).Conclusion The mTNM system incorporating LCR provides relatively accurate survival prediction in resected ICC patients.