Despite being affected by a disease with a high degree of mortality, patients with cholangiocarcinoma (CCA) have a variable prognosis since diagnosis in relation to various factors: the progress of the disease, the organic districts involved, the conditions general conditions of the patient, his immune status. The prediction of survival and response to therapies is an extremely important element in establishing the treatment strategy to be conducted. For this purpose, various scores have been proposed in the literature that combine and integrate different parameters. One of these scores, the ALAN score, was applied to a series of 45 patients with inoperable CCA, treated with second-line chemotherapy, to estimate their survival. In these patients both the ALAN score as a whole and the individual parameters that compose it were evaluated: neutrophil count +/- 8000 / mmc, serum albumin +/- 3.5 g / dl, neutrophil / lymphocyte ratio (NLR ) +/- 3, lymphocyte / monocyte ratio (MRL) +/- 2.1. Patients were stratified by survival rates and relative differences were evaluated for different stratification factors. Lower median survival was associated with lower albumin levels, higher neutrophil counts, higher NLR. Even when stratifying patients by ALAN score, median survival was significantly different. These data suggest that the ALAN score could be used for survival estimates in patients with inoperable CCA to undergo second-line chemotherapy. Some parameters that make it up, in particular the levels of albuminemia and the neutrophil count, seem to be able to define the prognosis of patients more accurately than the ALAN score in the standard version.
Pur essendo affetti da una malattia con un elevato grado di mortalità, i pazienti con colangiocarcinoma (CCA) presentano fin dalla diagnosi una prognosi variabile in relazione a diversi fattori: lo stato di avanzamento della malattia, i distretti organici che ne sono coinvolti, le condizioni generali del paziente, il suo stato immunitario. La predizione della sopravvivenza e della risposta alle terapie è un elemento estremamente rilevante per poter stabilire la strategia di cura da condurre. A questo scopo in letteratura sono stati proposti diversi score che combinano ed integrano diversi parametri. Uno di questi punteggi, l’ALAN score, è stato applicato ad una casistica di 45 pazienti affetti da CCA inoperabile, trattati con chemioterapia di seconda linea, per stimare la loro sopravvivenza. In tali pazienti sono stati valutati sia l’ALAN score nel suo complesso che i singoli parametri che lo compongono: conta dei neutrofili +/- 8000/mmc, albumina sierica +/- 3,5 g/dl, rapporto neutrofili/linfociti (NLR) +/- 3, rapporto linfociti/monociti (LMR) +/- 2,1. I pazienti sono stati stratificati per tassi di sopravvivenza e le relative differenze sono state valutate per i diversi fattori di stratificazione. Una minore sopravvivenza media è stata associata a livelli di albumina più bassi, ad una più alta conta dei neutrofili, ad un NLR più elevato. Anche stratificando i pazienti per punteggio ALAN, la sopravvivenza media risultava significativamente diversa. Questi dati suggeriscono che il punteggio ALAN potrebbe essere utilizzato per le stime di sopravvivenza in pazienti affetti da CCA non operabile da sottoporre a chemioterapia di seconda linea. Alcuni parametri che lo compongono, in particolare i livelli di albuminemia e la conta dei neutrofili, sembrano essere in grado di definire la prognosi dei pazienti in modo più accurato rispetto al punteggio ALAN nella versione standard.
Terapia di seconda linea per tumore delle vie biliari. Uno score prognostico per pazienti inoperabili.
MISERICORDIA, ALESSANDRO
2020/2021
Abstract
Despite being affected by a disease with a high degree of mortality, patients with cholangiocarcinoma (CCA) have a variable prognosis since diagnosis in relation to various factors: the progress of the disease, the organic districts involved, the conditions general conditions of the patient, his immune status. The prediction of survival and response to therapies is an extremely important element in establishing the treatment strategy to be conducted. For this purpose, various scores have been proposed in the literature that combine and integrate different parameters. One of these scores, the ALAN score, was applied to a series of 45 patients with inoperable CCA, treated with second-line chemotherapy, to estimate their survival. In these patients both the ALAN score as a whole and the individual parameters that compose it were evaluated: neutrophil count +/- 8000 / mmc, serum albumin +/- 3.5 g / dl, neutrophil / lymphocyte ratio (NLR ) +/- 3, lymphocyte / monocyte ratio (MRL) +/- 2.1. Patients were stratified by survival rates and relative differences were evaluated for different stratification factors. Lower median survival was associated with lower albumin levels, higher neutrophil counts, higher NLR. Even when stratifying patients by ALAN score, median survival was significantly different. These data suggest that the ALAN score could be used for survival estimates in patients with inoperable CCA to undergo second-line chemotherapy. Some parameters that make it up, in particular the levels of albuminemia and the neutrophil count, seem to be able to define the prognosis of patients more accurately than the ALAN score in the standard version.File | Dimensione | Formato | |
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TESI_rev_RB.pdf.zip
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https://hdl.handle.net/20.500.12075/1726