High-sensitivity modified Glasgow prognostic score (HS-mGPS) is a prognostic biomarker for small duct-type intrahepatic cholangiocarcinoma-a retrospective cohort study.

Abstract

Background: Serum biomarkers are often used as part of preoperative prediction strategies to help assess a patient's surgical risk and prognosis. The high-sensitivity modified Glasgow prognostic score (HS-mGPS) has been shown to offer better predictive accuracy compared to the traditional Glasgow prognostic score (GPS) and the modified Glasgow prognostic score (mGPS) in various cancers, but its ability to predict outcomes in patients with resected intrahepatic cholangiocarcinoma (ICC) has not been well-studied. The aim of the study was to investigate the prognostic value of HS-mGPS in ICC and its subtypes.

Methods: This study was a single-center retrospective study. All patients who were pathologically diagnosed with ICC after surgery in Nanjing Drum Tower Hospital from 2012 and 2022. Relevant laboratory data such as serum C-reactive protein (CRP), albumin (ALB), neutrophils, lymphocytes, and platelets were included. Overall survival (OS) information was collected, serum CRP and ALB level were used for scoring GPS, mGPS and HS-mGPS. Univariate and multivariate analyses were conducted to identify factors influencing prognosis by using Kaplan-Meier (KM) curve and Cox proportional hazards models. Additionally, through histological analysis, ICC was classified into large duct type (LD-type) and small duct type (SD-type), and the performance of the three scoring systems in these subtypes was examined.

Results: A total of 185 patients were included in this study, 57 cases were of the LD-type, and 128 cases were of the SD-type. Tumor subtypes was a significant factor influencing prognosis for all ICC patients [hazard ratio (HR) =1.76, 95% confidence interval (CI): 1.036-2.994, P=0.04]. HS-mGPS demonstrated a better ability to predict outcomes compared to GPS and mGPS, and was an independent prognostic factor of OS (HR =2.1, 95% CI: 1.001-4.374, P=0.049). HS-mGPS was also more effective in predicting prognosis for SD-type ICC compared to GPS and mGPS (HR =3.13, 95% CI: 1.018-9.604, P=0.046), while it was ineffective for LD-type ICC. Further analysis revealed that SD-type ICC with higher HS-mGPS scores typically had larger tumors and poorer differentiation, while LD-type ICC showed no significant differences.

Conclusions: HS-mGPS provides a more accurate prognostic indication for SD-type, but its effectiveness for LD-type requires further investigation with larger sample sizes. Therefore, for preoperatively biopsy-diagnosed SD-type ICC, the HS-mGPS has a certain level of prognostic predictive potential.