{
  "abstract": "Background: This study investigated an exploratory Combined Biomarker Score (CBS)—integrating the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score, Prognostic Nutritional Index (PNI), and lymph node ratio (LNR)—in resected ampullary adenocarcinoma, with methodological emphasis on censoring, score construction, collinearity, and internal validation. Methods: Data from 98 patients undergoing pancreaticoduodenectomy were analyzed retrospectively. The PNI was determined using the standard formula: (10 × albumin [g/dL]) + (0.005 × lymphocyte count [/mm3]), equivalent to albumin [g/L] + 5 × lymphocytes [×109/L]. Thirty-six-month cumulative/dynamic time-dependent ROC analysis with inverse-probability-of-censoring weighting was utilized to derive exploratory HALP, PNI, and LNR thresholds. Overall survival (OS) was evaluated using Kaplan–Meier and Cox proportional hazards regression. Spearman correlations, variance inflation factors, proportional-hazards diagnostics, alternative model specifications, apparent calibration, and 1000-resample full-procedure bootstrap validation were performed. Results: The mean PNI was 47.92 ± 6.36 (median 48.05, IQR 42.66–52.06). At 36 months, time-dependent AUCs were 0.579 for HALP, 0.567 for PNI, 0.512 for LNR, and 0.699 for the exploratory CBS. Optimized thresholds were established at HALP ≤ 26.784, PNI ≤ 46.20, and LNR ≥ 0.395. A high-risk CBS (2–3 adverse components) was observed in 27 of 98 patients and showed no statistically significant association with OS by log-rank testing (p = 0.142) or after adjustment for age and dichotomized stage (adjusted HR = 1.28, 95% CI: 0.58–2.80; p = 0.539). Age remained independently associated with OS (adjusted HR = 1.06 per year, p = 0.004). Model 4 (incorporating age, stage, and CBS) yielded an apparent Harrell C-index of 0.674 and a 36-month time-dependent AUC of 0.806; however, adding the CBS to age and stage did not significantly improve overall model fit (LR p = 0.543). Full-procedure bootstrap validation yielded an optimism-corrected C-index of 0.638. Conclusions: Evaluated via rigorous censoring-aware methodologies, the CBS currently serves as an exploratory framework rather than a validated clinical tool. While the score demonstrates moderate 36-month discrimination within this development cohort, it does not provide a statistically significant independent or incremental survival contribution beyond age and standard clinical variables. External validation and comprehensive clinicopathological adjustment are mandatory prior to any clinical translation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Gastroenterological Surgery, Başakşehir Çam and Sakura City Hospital, 34480 Istanbul, Turkey",
    "Department of General Surgery, Başakşehir Çam and Sakura City Hospital, 34480 Istanbul, Turkey",
    "Department of General Surgery, Arnavutköy State Hospital, 34480 Istanbul, Turkey"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Esin Şair"
    },
    {
      "affs": [
        1
      ],
      "name": "Orhan Şahin",
      "orcid": "0009-0000-0901-8352"
    },
    {
      "affs": [
        2
      ],
      "name": "Adnan Haşlak",
      "orcid": "0009-0000-6214-8850"
    },
    {
      "affs": [
        0
      ],
      "name": "Şeref Oray",
      "orcid": "0000-0002-5733-9772"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4gztgt79fvb8v.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15228778",
  "fulltext_url": null,
  "id": "4gztgt79fvb8v",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/22/8778",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-10",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/4gztgt79fvb8v.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T00:21:49Z",
      "native_id": "10.3390/jcm15228778",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/22/8778"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Beyond TNM Staging: Exploratory Integration of HALP, Prognostic Nutritional Index, and Lymph Node Ratio for Prognostic Assessment After Resection of Ampullary Adenocarcinoma",
  "title_text": "Beyond TNM Staging: Exploratory Integration of HALP, Prognostic Nutritional Index, and Lymph Node Ratio for Prognostic Assessment After Resection of Ampullary Adenocarcinoma",
  "type": "peer-reviewed",
  "updated_at": "2026-11-12T00:20:57Z",
  "url": "https://research.draconitic.com/paper/4gztgt79fvb8v",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}