External validation of plasma CSF1 as a preoperative prognostic marker in patients with resectable intrahepatic cholangiocarcinoma.

Akiki A, Jacobsson H, Nouairia G, Cornillet M, Björkström NK, Sparrelid E, Taflin H, Jansson H

Eur J Surg Oncol 51 (8) 110123 [2025-05-04; online 2025-05-04]

Long-term prognosis after resection for intrahepatic cholangiocarcinoma (iCCA) remains poor and the preoperative oncological risk assessment is difficult. Two immune system-related plasma proteins, colony stimulating factor 1 (CSF1) and TNF-related apoptosis-inducing ligand (TRAIL), were previously indicated as prognostic factors in iCCA. This study aimed to externally validate CSF1 and TRAIL as preoperative prognostic markers for patients with resectable iCCA. Preoperative plasma CSF1 and TRAIL concentrations (pg/mL) were determined from prospectively collected biobank samples by multiplex immunoanalysis, for patients with resectable iCCA operated at two tertiary referral centers. Primary outcome was overall survival (OS), analyzed by Kaplan-Meier method and Cox regression. Secondary outcome was disease-free survival (DFS). Discrimination was evaluated with concordance indices (C-index) and prognostic performance assessed with calibration curves. Sixty-one patients with resection for iCCA were included. CSF1 was associated with both OS (hazard ratio [HR] 1.03, 95 % confidence interval [CI] 1.01-1.05) and DFS (HR 1.02, 95 % CI 1.00-1.04). Median OS was eight months for patients with CSF1 levels in the upper quartile (≥158 pg/mL), compared to the overall median OS of 47 months. While TRAIL was not significantly associated with OS (P = 0.216), levels in the lower quartile (≤256 pg/mL) were associated with short DFS (P = 0.004). The C-index of CSF1 for OS was 0.70, with excellent calibration for three- and five-year OS. Preoperative plasma CSF1 was validated as a novel, well-calibrated predictor of poor survival in resectable iCCA, which could assist the preoperative risk assessment. Low plasma TRAIL was associated with early recurrence.

Affinity Proteomics Stockholm [Service]

PubMed 40347719

DOI 10.1016/j.ejso.2025.110123

Crossref 10.1016/j.ejso.2025.110123

pii: S0748-7983(25)00551-7