The relationship between the local and systemic inflammatory responses and survival in patients undergoing curative surgery for colon and rectal cancers

Roxburgh, C.S.D., Salmond, J.M., Horgan, P.G. , Oien, K.A. and McMillan, D.C. (2009) The relationship between the local and systemic inflammatory responses and survival in patients undergoing curative surgery for colon and rectal cancers. Journal of Gastrointestinal Surgery, 13(11), pp. 2011-2019. (doi: 10.1007/s11605-009-1034-0)

Abstract

<p><b>Introduction</b></p> <p>Both local (Klintrup criteria) and systemic (Glasgow Prognostic Score, mGPS) inflammatory responses have been reported to be independent predictors of cancer-specific survival in colorectal cancer. However, high-grade local inflammatory response appears more common in rectal and high mGPS more common in colonic tumors. Whether relationships with survival are similar in colon and rectal tumors is unclear. The present study assesses the prognostic value of local and systemic inflammation in colon and rectal cancers and defines 3-year survival according to inflammation-based criteria for stage II/III disease.</p> <p><b>Methods</b></p> <p>Two hundred forty colon and 140 rectal cancer patients underwent potentially curative surgery between 1997 and 2007. C-reactive protein and albumin (mGPS) were measured preoperatively. Routine pathology specimens were scored according to Klintrup criteria for peritumoral infiltrate.</p> <p><b>Results</b></p> <p>Patients with colon cancers were older (P <0.05) and had higher T stage (P < 0.001) and mGPS (P ≤  0.001) compared with rectal cancers. The proportions of patients with a high-grade tumor inflammatory cell infiltrate were similar in colon and rectal cancers. mGPS and Klintrup criteria were independent predictors of cancer survival. The mGPS hazard ratios were 1.56 and 1.76 for the mGPS, and the Klintrup hazard ratios were 2.12 and 5.74 for colon and rectum, respectively. For stages II and III colorectal cancer, 3-year survival was 91% and 73%, respectively. Three-year survival varied between 100% and 68% depending on Klintrup score/ mGPS in stage II disease and between 97% and 60% in stage III disease.</p> <p><b>Conclusion</b></p> <p>Local and systemic inflammatory responses are important independent predictors of survival in colon and rectal cancers. These scores combined with tumor–node–metastases stage improve the prediction of survival in these patients.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and McMillan, Professor Donald and Oien, Professor Karin and Salmond, Dr Jonathan
• Authors: Roxburgh, C.S.D., Salmond, J.M., Horgan, P.G., Oien, K.A., and McMillan, D.C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Journal of Gastrointestinal Surgery
• ISSN: 1091-255X
• Published Online: 19 September 2009