The Glasgow Microenvironment Score and risk and site of recurrence in TNM I–III colorectal cancer

Alexander, P.G., van Wyk, H.C. , Pennel, K.A.F., Hay, J., McMillan, D.C. , Horgan, P.G. , Roxburgh, C.S.D. , Edwards, J. and Park, J.H. (2023) The Glasgow Microenvironment Score and risk and site of recurrence in TNM I–III colorectal cancer. British Journal of Cancer, 128(4), pp. 556-567. (doi: 10.1038/s41416-022-02069-x) (PMID:36476660) (PMCID:PMC9938140)

Abstract

Background: Glasgow Microenvironment Score (GMS) stratifies long-term survival into three groups based on tumour phenotype: peritumoural inflammation (Klintrup–Mäkinen (KM)) and tumour stroma percentage (TSP). However, it is not known if the location of disease recurrence is influenced by the GMS category. Methods: Seven hundred and eighty-three TNM I–III colorectal cancers (CRC) were included. GMS (GMS0—high KM; GMS1—low KM, low TSP; GMS2—low KM, high TSP) and cancer-specific survival (CSS), overall survival (OS) and disease recurrence were assessed using Cox regression analysis. Results: Of the 783 patients, 221 developed CRC recurrence; 65 developed local recurrence + systemic disease. GMS was independent for CSS (HR 1.50, 95% CI 1.17–1.92, p < 0.001) and OS (HR 1.23, 1.05–1.44, p = 0.01). Higher GMS category was associated with T-stage, N-stage, emergency presentation and venous invasion. GMS was independent for local+systemic recurrence (HR 11.53, 95% CI 1.45–91.85, p = 0.04) and distant-only recurrence (HR 3.01, 95% CI 1.59–5.71, p = 0.002). GMS 2 disease did not appear to have statistically better outcomes with adjuvant chemotherapy in high-risk disease. Conclusion: Although confounded by a higher rate of T4 and node-positive disease, GMS 1 and 2 are associated with an increased risk of local and distant recurrence. GMS is an independent poor prognostic indicator for recurrent colorectal cancer. Higher GMS patients may benefit from enhanced postoperative surveillance.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Park, Mr James and Horgan, Professor Paul and Pennel, Miss Kathryn and Roxburgh, Professor Campbell and Hay, Dr Jennifer and Edwards, Professor Joanne and Alexander, Peter and McMillan, Professor Donald and Van Wyk, Dr Hester
• Authors: Alexander, P.G., van Wyk, H.C., Pennel, K.A.F., Hay, J., McMillan, D.C., Horgan, P.G., Roxburgh, C.S.D., Edwards, J., and Park, J.H.
• 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
• Journal Name: British Journal of Cancer
• Publisher: Springer Nature
• ISSN: 0007-0920
• ISSN (Online): 1532-1827
• Published Online: 07 December 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in British Journal of Cancer 128(4): 556-567
• Publisher Policy: Reproduced under a Creative Commons License