The relationship between systemic inflammatory response, screen detection and outcome in colorectal cancer

Johnstone, M. S., McSorley, S. T. , McMillan, D. C. , Horgan, P. G. and Mansouri, D. (2024) The relationship between systemic inflammatory response, screen detection and outcome in colorectal cancer. Colorectal Disease, 26(1), pp. 81-94. (doi: 10.1111/codi.16824) (PMID:38095280)

Abstract

Aim: A raised systemic inflammatory response correlates with poorer colorectal cancer (CRC) outcomes. Faecal immunochemical test bowel screening aims to detect early-stage disease. We assessed the relationship between systemic inflammatory response, screen detection and CRC survival. Method: A retrospective, observational cohort study compared screen-detected and non-screen-detected CRC patients undergoing resection. Systemic inflammatory response was measured using lymphocyte/monocyte, neutrophil/lymphocyte and platelet/lymphocyte ratios (LMR, NLR, PLR). Covariables were compared using χ2 testing and survival with Cox regression. Results: A total of 761 patients were included (326 screen-detected, 435 non-screen-detected). Screen-detected patients had lower systemic inflammatory response: low (<2.4) LMR (28.8% vs. 44.6%; P < 0.001), moderate (3–5) or high (>5) NLR (26.1% vs. 30.6%, P < 0.001; and 7.7% vs. 19.5%, P < 0.001) and high (>150) PLR (47.2% vs. 64.6%; P < 0.001). Median follow-up was 63 months. On univariate analysis, non-screen detection (hazard ratio [HR] 2.346, 95% CI 1.687–3.261; P < 0.001), advanced TNM (P < 0.001), low LMR (HR 2.038, 95% CI 1.514–2.742; P < 0.001), moderate NLR (HR 1.588, 95% CI 1.128–2.235; P = 0.008), high NLR (HR 2.382, 95% CI 1.626–3.491; P < 0.001) and high PLR (HR 1.827, 95% CI 1.326–2.519; P < 0.001) predicted poorer overall survival (OS). Non-screen detection (HR 2.713, 95% CI 1.742–4.226; P < 0.001), TNM (P < 0.001), low LMR (HR 1.969, 95% CI 1.340–2.893; P < 0.001), high NLR (HR 2.368, 95% CI 1.448–3.875; P < 0.001) and high PLR (HR 2.110, 95% CI 1.374–3.240; P < 0.001) predicted poorer cancer-specific survival (CSS). On multivariate analysis, non-screen detection (HR 1.698, 95% CI 1.152–2.503; P = 0.008) and low LMR (HR 1.610, 95% CI 1.158–2.238; P = 0.005) independently predicted poorer OS. Non-screen detection (HR 1.847, 95% CI 1.144–2.983; P = 0.012) and high PLR (HR 1.578, 95% CI 1.018–2.444; P = 0.041) predicted poorer CSS. Conclusion: Screen-detected CRC patients have a lower systemic inflammatory response. Non-screen detection and systemic inflammatory response (measured by LMR and PLR respectively) were independent predictors of poorer OS and CSS.

• Item Type: Articles
• Keywords: Cancer, inflammation, screening, SIR, colorectal.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mansouri, Mr David and Johnstone, Mr Mark and Horgan, Professor Paul and McMillan, Professor Donald and McSorley, Dr Stephen

Creator Roles

Johnstone, M. S.: Data curation, Formal analysis, Investigation, Writing – original draft, Methodology, Validation
McSorley, S. T.: Supervision, Writing – review and editing
McMillan, D. C.: Writing – review and editing, Supervision
Horgan, P. G.: Writing – review and editing, Supervision
Mansouri, D.: Writing – review and editing, Conceptualization, Methodology, Data curation, Supervision, Investigation

• Authors: Johnstone, M. S., McSorley, S. T., McMillan, D. C., Horgan, P. G., and Mansouri, D.
• 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: Colorectal Disease
• Publisher: Wiley
• ISSN: 1462-8910
• ISSN (Online): 1463-1318
• Published Online: 14 December 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Colorectal Disease 26(1):81-94
• Publisher Policy: Reproduced under a Creative Commons License