The influence of systemic inflammation on treatment response and survival in anal squamous cell cancer

Knight, K., Choong, J.X., McKee, R.F., Anderson, J.H., Horgan, P.G. , McMillan, D.C. , McDonald, A. and Roxburgh, C.S. (2021) The influence of systemic inflammation on treatment response and survival in anal squamous cell cancer. Clinical Oncology, 33(1), e22-e30. (doi: 10.1016/j.clon.2020.06.010) (PMID:32709540)

Abstract

AIMS:The incidence of anal squamous cell cancer (SCCA) is rising. Although chemoradiotherapy (CRT) provides a chance of cure, a proportion of patients have an incomplete response or develop recurrence. This study assessed the value of inflammation-based prognostic indicators, including the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR), in patients with SCCA treated by CRT with curative intent. MATERIAL AND METHODS:Patients with histologically confirmed SCCA were identified from pathology records. Medical records were retrospectively reviewed and clinical, pathological and treatment characteristics were abstracted. The mGPS (0 = normal C-reactive protein [CRP] and albumin, 1 = CRP >10 mg/l and 2 = CRP >10 mg/l and albumin <35 mg/l) and NLR were calculated from routine blood tests obtained prior to CRT. RESULTS:In total, 118 patients underwent CRT for SCCA between December 2007 and February 2018. Of these, 99 patients had appropriate pretreatment blood results available. Systemic inflammation as indicated by NLR >3 and mGPS >0 was present in 41% and 39% of patients, respectively. Most patients had T2 or larger tumours (n = 85, 86%) without nodal involvement (n = 64, 65%). An elevated mGPS was associated with more advanced T-stage (56% versus 35%, P = 0.036). NLR >5 was associated with nodal positivity (56% versus 31%, P = 0.047). On multivariate analysis, more advanced T-stage (odds ratio 7.49, 95% confidence interval 1.51-37.20, P = 0.014) and a raised mGPS (odds ratio 5.13, 95% confidence interval 1.25-21.14, P = 0.024) were independently related to incomplete CRT response. An elevated mGPS was prognostic of inferior survival (hazard ratio 3.09, 95% confidence interval 1.47-6.50, P = 0.003) and cancer-specific survival (hazard ratio 4.32, 95% confidence interval 1.54-12.15, P = 0.006), independent of TNM stage. CONCLUSION:Systemic inflammation, as measured by the mGPS, is associated with an incomplete CRT response and is independently prognostic of inferior survival in patients with SCCA. The mGPS may offer a simple marker of inferior outcome that could be used to identify high-risk patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and Roxburgh, Professor Campbell and McKee, Dr Ruth and McMillan, Professor Donald and Knight, Miss Katrina
• Authors: Knight, K., Choong, J.X., McKee, R.F., Anderson, J.H., Horgan, P.G., McMillan, D.C., McDonald, A., and Roxburgh, C.S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Oncology
• Publisher: Elsevier
• ISSN: 0936-6555
• ISSN (Online): 1433-2981
• Published Online: 21 July 2020
• Copyright Holders: Copyright © 2020 The Royal College of Radiologists
• First Published: First published in Clinical Oncology 33(1): e22-e30
• Publisher Policy: Reproduced in accordance with the publisher copyright policy