Relationship between preoperative comorbidity, systemic inflammatory response, and survival in patients undergoing curative resection for colorectal cancer.

Roxburgh, C.S.D., Platt, J.J., Leitch, E.F., Kinsella, J., Horgan, P.G. and McMillan, D.C. (2011) Relationship between preoperative comorbidity, systemic inflammatory response, and survival in patients undergoing curative resection for colorectal cancer. Annals of Surgical Oncology, 18(4), pp. 997-1005. (doi:10.1245/s10434-010-1410-8)

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Abstract

Besides tumor characteristics, colorectal cancer (CRC) outcomes are also determined by host factors, in particular the systemic inflammatory response. The basis of this relationship with survival is not known; however, systemic inflammation may reflect comorbidity. The present study examines relationships between host factors (including age, comorbidity, deprivation, and systemic inflammation) and survival in CRC. A total of 302 patients underwent curative elective CRC resection between 1997 and 2005. Data was collected on patient comorbidity (Charlson Comorbidity Index [CCI], Lee Cardiac Risk Index [LCRI], National Institute on Aging and National Cancer Institute Comorbidity Index [NIA/NCI], and Adult Comorbidity Evaluation-27 [ACE-27]), systemic inflammatory response (Glasgow Prognostic Score [mGPS]), deprivation [Carstairs Deprivation Index], body mass index, and smoking status. For cancer-specific survival, age (P = 0.047), tumor, node, metastasis system stage (P < 0.001), high-risk Petersen Index (P < 0.001), LCRI (P = 0.021), and mGPS (P < 0.001) were independent factors by multivariate analysis. For overall survival, age (P < 0.001), tumor, node, metastasis system stage (P = 0.001), high-risk Petersen Index (P = 0.002), postoperative infective complications (P = 0.002), ACE-27 (P = 0.008), and mGPS (P < 0.001) were independent factors. Older age related to increasing comorbidity (ACE-27, CCI, LCRI [P < 0.005]) and increased mGPS (P < 0.005). Smoking and deprivation related to increasing comorbidity (P < 0.05). The mGPS was associated with high comorbidity burden assessed with ACE-27 (P = 0.065), CCI (P = 0.016), LCRI (P = 0.095), and NIA/NCI (P = 0.084). Comorbidity does not fully explain the relationship between the mGPS and cancer-specific survival in CRC patients. Furthermore, comorbidity, in particular that measured by the LCRI, is an important independent indicator of cancer survival.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Horgan, Professor Paul and McMillan, Professor Donald and Kinsella, Professor John and Roxburgh, Dr Campbell
Authors: Roxburgh, C.S.D., Platt, J.J., Leitch, E.F., Kinsella, J., Horgan, P.G., and McMillan, D.C.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
Journal Name:Annals of Surgical Oncology
ISSN:1068-9265
Published Online:02 November 2010

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