Hoshimoto S, et al. - In this retrospective cohort analysis, researchers assessed the prognostic significance of a group of preoperative hematological inflammatory parameters for survival in 53 patients with distal cholangiocarcinoma (DCC) who had pancreaticoduodenectomy with curative intent. Time-dependent receiver operating characteristic analysis was performed to define optimal cutoff values of hematological inflammatory parameters, including the absolute lym­phocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). In multivariate analysis, portal vein invasion and high PLR were identified as independent prognostic factors for overall survival (OS) and high PLR and number of positive lymph nodes (≥3) were found as independent prognostic factors for disease-free survival (DFS). Overall, findings highlighted the possible utility of preoperative PLR evaluation for identifying high-risk DCC patients undergoing surgical resection for aggressive adjuvant therapy.