Skip to main content

Advertisement

SpringerLink
Log in

Prognostic Role of a New Index Tested in European and Korean Advanced Biliary Tract Cancer Patients: the PECS Index

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Background and Aim

The aim of the present study is to evaluate a new index (PECS (PsECogSii)index) influenced by PS ECOG and systemic immune-inflammation index (SII) in unresectable locally advanced or metastatic BTC patients treated with first-line chemotherapy.

Methods

This multicenter, international, study was conducted on a training cohort of 130 patients and in three European and Korean validation cohorts The PECS index was calculated as ECOG × SII index (neutrophil count × platelet count/lymphocyte count). Event-time distributions were estimated using the Kaplan–Meier method and survival curves were compared using the log-rank test.

Results

In the training cohort, the median overall survival (mOS) was 13.2 months, 8.7 months, and 3.8 months for patients with PECS-0, PECS-1, and PECS-2, respectively (PECS-0: HR = 1; PECS-1: HR 1.41; PECS-2: HR 3.23) (p < 0.0001). In the first validation cohort, the mOS was 12.8 months, 10.1 months, and 5.3 months for patients with PECS-0, PECS-1, and PECS-2, respectively (PECS-0: HR = 1; PECS-1: HR 1.29; PECS-2: HR 2.40) (p < 0.0001). In the second validation cohort, the mOS was 21.2 months, 10.2 months, and 3.0 months for patients with PECS-0, PECS-1, and PECS-2, respectively (PECS-0: HR = 1; PECS-1: HR 2.25; PECS-2: HR 9.00) (p < 0.0001). In the third validation cohort, the median OS was 15.5 months, 7.5 months, and 3.7 months for patients with PECS-0, PECS-1, and PECS-2, respectively (PECS-0: ref HR = 1; PECS-1: HR 2.14; PECS-2: HR 5.00) (p < 0.0001). Multivariate analysis in all cohorts confirmed the PECS index as an independent prognostic factor for OS.

Conclusions

The easy assessment, low cost, and reproducibility make PECS index a promising tool to assess the prognosis of BTC patients in future clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of Data and Materials

On request.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.

    Article  PubMed  Google Scholar 

  2. Hyder O, Hatzaras I, Sotiropoulos GC, et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153(6):811–8.

    Article  PubMed  Google Scholar 

  3. Zhang XF, Beal EW, Bagante F, et al. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent. Br J Surg. 2018;105(7):848–56.

    Article  PubMed  Google Scholar 

  4. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.

    Article  CAS  PubMed  Google Scholar 

  5. Kim BJ, Hyung J, Yoo C, et al. Prognostic factors in patients with advanced biliary tract cancer treated with first-line gemcitabine plus cisplatin: retrospective analysis of 740 patients. Cancer Chemother Pharmacol. 2017a;80(1):209–15.

    Article  CAS  PubMed  Google Scholar 

  6. Park HS, Park JS, Chun YJ, et al. Prognostic factors and scoring model for survival in metastatic biliary tract cancer. Cancer Res Treat. 2017;49(4):1127–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. McNamara MG, Templeton AJ, Maganti M, et al. Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer. Eur J Cancer. 2014a;50(9):1581–9.

    Article  CAS  PubMed  Google Scholar 

  8. Faloppi L, Del Prete M, Casadei Gardini A, et al. The correlation between LDH serum levels and clinical outcome in advanced biliary tract cancer patients treated with first line chemotherapy. Sci Rep. 2016;6:24136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Park I, Lee JL, Ryu MH, et al. Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first-line palliative chemotherapy. Cancer. 2009a;115(18):4148–55.

    Article  CAS  PubMed  Google Scholar 

  10. Suzuki Y, Kan M, Kimura G, et al. Predictive factors of the treatment outcome in patients with advanced biliary tract cancer receiving gemcitabine plus cisplatin as first-line chemotherapy. J Gastroenterol. 2019;54(3):281–90.

    Article  CAS  PubMed  Google Scholar 

  11. Salati M, Filippi R, Vivaldi C, et al. The prognostic nutritional index predicts survival and response to first-line chemotherapy in advanced biliary cancer [published online ahead of print, 2019 Nov 27]. Liver Int. 2019;https://doi.org/10.1111/liv.14314.

  12. Peixoto RD, Renouf D, Lim H. A population based analysis of prognostic factors in advanced biliary tract cancer. J Gastrointest Oncol. 2014a;5(6):428–32.

    PubMed  PubMed Central  Google Scholar 

  13. Bridgewater J, Lopes A, Wasan H, et al. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2016a;27(1):134–40.

    Article  CAS  PubMed  Google Scholar 

  14. Fornaro L, Cereda S, Aprile G, et al. Multivariate prognostic factors analysis for second-line chemotherapy in advanced biliary tract cancer. Br J Cancer. 2014a;110(9):2165–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Duffy AG, Makarova-Rusher OV, Greten TF. The case for immune-based approaches in biliary tract carcinoma. Hepatology. 2016;64(5):1785–91.

    Article  PubMed  Google Scholar 

  17. Cools-Lartigue J, Spicer J, McDonald B, et al. Neutrophil extracellular traps sequester circulating tumor cells and promote metastasis [published online ahead of print, 2013 Jul 1]. J Clin Invest. 2013;123(8):3446–3458.

  18. Labelle M, Begum S, Hynes RO. Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis. Cancer Cell. 2011a;20(5):576–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008a;454(7203):436–44.

    Article  CAS  PubMed  Google Scholar 

  20. Casadei Gardini A, Scarpi E, Faloppi L, et al. Immune inflammation indicators and implication for immune modulation strategies in advanced hepatocellular carcinoma patients receiving sorafenib. Oncotarget. 2016a;7(41):67142–9.

    Article  PubMed  Google Scholar 

  21. Casadei Gardini A, Marisi G, Canale M, et al. Radiofrequency ablation of hepatocellular carcinoma: a meta-analysis of overall survival and recurrence-free survival. Onco Targets Ther. 2018;11:6555–67.

    Article  PubMed  Google Scholar 

  22. Casadei Gardini A, Foschi FG, Conti F, et al. Immune inflammation indicators and ALBI score to predict liver cancer in HCV-patients treated with direct-acting antivirals. Dig Liver Dis. 2019;51(5):681–8.

    Article  CAS  PubMed  Google Scholar 

  23. Casadei-Gardini A, Montagnani F, Casadei C, et al. Immune inflammation indicators in anal cancer patients treated with concurrent chemoradiation: training and validation cohort with online calculator (ARC: Anal Cancer Response Classifier) [published correction appears in Cancer Manag Res. 2019 Jun 25;11:5123]. Cancer Manag Res. 2019;11:3631–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107(4):695–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204–12.

    Article  CAS  PubMed  Google Scholar 

  26. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.

  27. Gu L, Li H, Chen L, et al. Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis. Oncotarget. 2016;7(22):31926–42.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Geng Y, Shao Y, Zhu D, et al. Systemic immune-inflammation index predicts prognosis of patients with esophageal squamous cell carcinoma: a propensity score-matched analysis . Sci Rep. 2016;6:39482.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22.

    Article  CAS  PubMed  Google Scholar 

  30. Prognostic factors in unresectable biliary tract cancer: a GICO (Gruppo Italiano COlangiocarcinoma) retrospective analysis. Ann Oncol. 2017.

  31. McNamara MG, Templeton AJ, Maganti M, et al. Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer. Eur J Cancer. 2014b;50(9):1581–9.

    Article  CAS  PubMed  Google Scholar 

  32. Peixoto RD, Renouf D, Lim H. A population based analysis of prognostic factors in advanced biliary tract cancer. J Gastrointest Oncol. 2014b;5(6):428–32.

    PubMed  PubMed Central  Google Scholar 

  33. Bridgewater J, Lopes A, Wasan H, et al. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer. Ann Oncol. 2016b;27(1):134–40.

    Article  CAS  PubMed  Google Scholar 

  34. Kim BJ, Hyung J, Yoo C, et al. Prognostic factors in patients with advanced biliary tract cancer treated with first-line gemcitabine plus cisplatin: retrospective analysis of 740 patients. Cancer Chemother Pharmacol. 2017b;80(1):209–15.

    Article  CAS  PubMed  Google Scholar 

  35. Fornaro L, Cereda S, Aprile G, et al. Multivariate prognostic factors analysis for second-line chemotherapy in advanced biliary tract cancer. Br J Cancer. 2014b;110(9):2165–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Park I, Lee JL, Ryu MH, et al. Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first-line palliative chemotherapy. Cancer. 2009b;115(18):4148–55.

    Article  CAS  PubMed  Google Scholar 

  37. Bridgewater J, Palmer D, Cunningham D, et al. Outcome of second-line chemotherapy for biliary tract cancer. Eur J Cancer. 2013;49(6):1511.

    Article  CAS  PubMed  Google Scholar 

  38. Cereda S, Belli C, Rognone A, Mazza E, Reni M. Second-line therapy in advanced biliary tract cancer: what should be the standard? Crit Rev Oncol Hematol. 2013;88(2):368–74.

    Article  PubMed  Google Scholar 

  39. Park HS, Park JS, Chun YJ, et al. Prognostic factors and scoring model for survival in metastatic biliary tract cancer. Cancer Res Treat. 2017;49(4):1127–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Casadei Gardini A, Scarpi E, Faloppi L, et al. Immune inflammation indicators and implication for immune modulation strategies in advanced hepatocellular carcinoma patients receiving sorafenib. Oncotarget. 2016b;7(41):67142–9.

    Article  PubMed  Google Scholar 

  41. Conroy G, Salleron J, Belle A, et al. The prognostic value of inflammation-based scores in advanced hepatocellular carcinoma patients prior to treatment with sorafenib. Oncotarget. 2017;8(56):95853–95864. Published 2017 Sep 30.

  42. Passardi A, Scarpi E, Cavanna L, et al. Inflammatory indexes as predictors of prognosis and bevacizumab efficacy in patients with metastatic colorectal cancer. Oncotarget. 2016;7(22):33210–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wang K, Diao F, Ye Z, et al. Prognostic value of systemic immune-inflammation index in patients with gastric cancer. Chin J Cancer. 2017;36(1):75. Published 2017 Sep 12.

  44. Wang L, Wang C, Wang J, Huang X, Cheng Y. A novel systemic immune-inflammation index predicts survival and quality of life of patients after curative resection for esophageal squamous cell carcinoma. J Cancer Res Clin Oncol. 2017;143(10):2077–86.

    Article  PubMed  Google Scholar 

  45. Lolli C, Basso U, Derosa L, et al. Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Oncotarget. 2016;7(34):54564–71.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med. 2015;236(4):297–304.

    Article  CAS  PubMed  Google Scholar 

  47. Tong YS, Tan J, Zhou XL, Song YQ, Song YJ. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med. 2017;15(1):221. Published 2017 Oct 31.

  48. Yu J, Wu X, Yu H, et al. Systemic Immune-inflammation index and circulating T-cell immune index predict outcomes in high-risk acral melanoma patients treated with high-dose interferon. Transl Oncol. 2017;10(5):719–25.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Labelle M, Begum S, Hynes RO. Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis. Cancer Cell. 2011b;20(5):576–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Schumacher D, Strilic B, Sivaraj KK, Wettschureck N, Offermanns S. Platelet-derived nucleotides promote tumor-cell transendothelial migration and metastasis via P2Y2 receptor. Cancer Cell. 2013;24(1):130–7.

    Article  CAS  PubMed  Google Scholar 

  51. Gil-Bernabé AM, Ferjancic S, Tlalka M, et al. Recruitment of monocytes/macrophages by tissue factor-mediated coagulation is essential for metastatic cell survival and premetastatic niche establishment in mice. Blood. 2012;119(13):3164–75.

    Article  PubMed  CAS  Google Scholar 

  52. Chen HC, Lin HC, Liu CY, et al. Neutrophil elastase induces IL-8 synthesis by lung epithelial cells via the mitogen-activated protein kinase pathway. J Biomed Sci. 2004;11(1):49–58.

    Article  PubMed  Google Scholar 

  53. De Larco JE, Wuertz BR, Furcht LT. The potential role of neutrophils in promoting the metastatic phenotype of tumors releasing interleukin-8. Clin Cancer Res. 2004;10(15):4895–900.

    Article  PubMed  Google Scholar 

  54. Houghton AM, Rzymkiewicz DM, Ji H, et al. Neutrophil elastase-mediated degradation of IRS-1 accelerates lung tumor growth. Nat Med. 2010;16(2):219–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008b;454(7203):436–44.

    Article  CAS  PubMed  Google Scholar 

  56. Ha H, Nam AR, Bang JH, et al. Soluble programmed death-ligand 1 (sPDL1) and neutrophil-to-lymphocyte ratio (NLR) predicts survival in advanced biliary tract cancer patients treated with palliative chemotherapy. Oncotarget. 2016 Nov 22.

Download references

Author information

Authors and Affiliations

  1. Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy

    Giulia Rovesti & Francesco Caputo

  2. Division of Medical Oncology, ASL BI, Nuovo Ospedale Degli Infermi, Ponderano, Italy

    Francesco Leone, Andrea Palloni & Stefania De Lorenzo

  3. Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Saint Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Giovanni Brandi

  4. Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126, Pisa, Italy

    Lorenzo Fornaro, Caterina Vivaldi & Enrico Vasile

  5. Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy

    Mario Scartozzi & Eleonora Lai

  6. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy

    Monica Niger, Federico Nichetti & Filippo de Braud

  7. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Changhoon Yoo, Hyungwoo Cho, Filippo de Braud & Jae Ho Jeong

  8. Department of Oncology, Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy

    Roberto Filippi & Filippo de Braud

  9. Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria Della Misericordia, Udine, Italy

    Mariaelena Casagrande, Nicoletta Pella & Filippo de Braud

  10. Medical Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy

    Nicola Silvestris & Filippo de Braud

  11. Medical Oncology Department, Campus Biomedico University, Roma, Italy

    Daniele Santini & Filippo de Braud

  12. Oncology Unit, Macerata Hospital, Macerata, Italy

    Luca Faloppi & Filippo de Braud

  13. Department of Oncology, Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, University of Turin, Candiolo, Turin, Italy

    Massimo Aglietta & Filippo de Braud

  14. Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy

    Elisabetta Fenocchio & Filippo de Braud

  15. Department of Oncology, Medical Oncology Unit, Ordine Mauriziano Hospital, University of Turin, Turin, Italy

    Massimo Di Maio & Filippo de Braud

  16. Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, Vicenza, Italy

    Filippo de Braud

  17. University of Milan, Milan, Italy

    Filippo de Braud

  18. Department of Medical Oncology, Università Vita-Salute, San Raffaele Hospital IRCCS, Milan, Italy

    Giulia Orsi, Stefano Cascinu & Andrea Casadei-Gardini

Authors
  1. Giulia Rovesti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Brandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Fornaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Scartozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monica Niger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Changhoon Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Caputo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Roberto Filippi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mariaelena Casagrande
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nicola Silvestris
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Daniele Santini
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Luca Faloppi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Andrea Palloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Massimo Aglietta
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Caterina Vivaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Hyungwoo Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Eleonora Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Elisabetta Fenocchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Federico Nichetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Nicoletta Pella
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Stefania De Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Massimo Di Maio
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Enrico Vasile
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Filippo de Braud
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Jae Ho Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Giuseppe Aprile
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Giulia Orsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Stefano Cascinu
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Andrea Casadei-Gardini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: A. Casadei Gardini, G Rovesti. Acquisition of data (acquired and managed patients): Giulia Rovesti, Francesco Leone,Giovanni Brandi, Lorenzo Fornaro, Mario Scartozzi, Monica Niger, Changhoon Yoo, Francesco Caputo, Roberto Filippi, Mariaelena Casagrande, Nicola Silvestris, Daniele Santini, Luca Faloppi, Andrea Palloni, Massimo Aglietta, Caterina Vivaldi, Hyungwoo Cho, Eleonora Lai, Elisabetta Fenocchio, Federico Nichetti, Nicoletta Pella, Stefania De Lorenzo, Massimo Di Maio, Enrico Vasile, Filippo de Braud, Jae Ho Jeong, Giuseppe Aprile, Giulia Orsi, Stefano Cascinu, Andrea Casadei-Gardini Analysis and interpretation of data: A. Casadei Gardini, G Rovesti. Writing, review, and/or revision of the manuscript: A. Casadei Gardini, G Rovesti. Final approval of manuscript: All authors.

Corresponding author

Correspondence to Andrea Casadei-Gardini.

Ethics declarations

Ethics Approval and Consent to Participate

Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study.

Informed Consent

All patients signed the informed consent.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rovesti, G., Leone, F., Brandi, G. et al. Prognostic Role of a New Index Tested in European and Korean Advanced Biliary Tract Cancer Patients: the PECS Index. J Gastrointest Canc 53, 289–298 (2022). https://doi.org/10.1007/s12029-021-00596-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-021-00596-z

Keywords

Search

Navigation