Neutrophil percentage-to-albumin and carbohydrate antigen 19-9 stratified score predicts postoperative recurrence in biliary tract cancer.

Authors

Yu-Ting Cai, Dao-Cheng Zhan, Yong-Shuai Wang, Ai-Di Jiang, Wei Jia, Cong Xu, Xiao-Xiu Hu, Heng-Jun Wu, Yi-Ming Xue, Zhong-Ni Wu, Hao Chen, Wei Wang

Published in

Hepatobiliary & pancreatic diseases international : HBPD INT. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Biliary tract cancer (BTC) has a high postoperative recurrence rate and limiting long-term survival. Accurate prediction of recurrence is vital for clinical management. Carbohydrate antigen 19-9 (CA19-9) and the neutrophil percentage-to-albumin ratio (NPAR) are established prognostic markers in various cancers, but their combined value in BTC remains unclear. This study assessed the predictive role of the combination of CA19-9 and NPAR on time to recurrence (TTR) and introduced the novel NPAR-CA19-9 stratified score (NCSS).
A total of 145 BTC patients who underwent resection between March 2019 and December 2023 were analyzed. Preoperative blood samples, collected within two weeks of surgery, were used to measure CA19-9 and NPAR. Cutoff values were defined using the Maximum Selected Rank Statistic (MSRS). NCSS (0-2) were assigned according to marker levels and evaluated using Kaplan-Meier survival analysis and Cox regression models.
Higher NCSS were associated with shorter TTR and reduced overall survival (P < 0.001). Cox regression confirmed NCSS as an independent predictor of recurrence [NCSS = 1: hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.05-3.14; NCSS = 2: HR = 2.95, 95% CI: 1.54-5.64] and overall survival (NCSS = 1: HR = 5.21, 95% CI: 1.19-22.82; NCSS = 2: HR = 11.88, 95% CI: 2.44-57.75). Subgroup analysis showed that patients with NCSS = 1 or 2 benefited from adjuvant chemotherapy, whereas those with NCSS = 0 did not. Incorporating NCSS into a nomogram improved prediction of TTR compared with a model excluding NCSS (C-index: 0.72 vs. 0.70; P = 0.027).
NCSS is a novel, simple, and effective preoperative scoring system that predicts TTR and overall survival in BTC patients, supporting more individualized treatment planning.

PMID:
42567780
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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