Comorbidity and systemic inflammation are independent prognostic factors in patients with colorectal cancer: A ScotScan collaborative study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 707-707
Author(s):  
James Hugh Park ◽  
Anniken Fuglestad ◽  
Anne Helene Kostner ◽  
Antonia K. Roseweir ◽  
Joanne Edwards ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systemic Inflammation ◽  
Inflammatory Responses ◽  
Prognostic Score ◽  
Collaborative Study ◽  
Glasgow Prognostic Score ◽  
Clinicopathological Characteristics ◽  
Stage Ii ◽  
Royal Infirmary ◽  
Modified Glasgow Prognostic Score

707 Background: Although inextricably linked, both comorbidity and systemic inflammatory responses have been shown to determine survival in patients undergoing surgery for colorectal cancer (CRC). The present study examines the interrelationships between comorbidity (ASA grade) and systemic inflammation (modified Glasgow Prognostic Score (mGPS)) in patients from the ScotScan dataset. Methods: Clinicopathological characteristics and outcome of consecutive patients undergoing potentially curative resection of TNM I-III CRC in Glasgow Royal Infirmary (Scotland) and Sørlandet Hospital (Norway) were prospectively collected. ASA grade and mGPS (0-CRP ≤ 10mg/L, 1-CRP > 10mg/L, 2-CRP > 10mg/L and albumin < 35g/L) prior to surgery was recorded and relationship with overall survival (OS) examined. Results: 2,295 patients (Scotland: n = 1,234 , Norway: n = 1,061) were included. Patients from Norway were more likely to be older, female and have higher ASA grade (all P < 0.001), and more likely to have colon cancer (76% vs. 67%, P < 0.001). Patients from Norway were less likely to be systemically inflamed (mGPS = 0: 72% vs. 65%, P < 0.001), even after propensity score matching ( n = 736, OR 0.36 95%CI0.25-0.51, P < 0.001). ASA grade and mGPS were significantly associated; 21% of ASA 1 patients had mGPS ≥ 1 compared to 41% of ASA four patients ( P < 0.001). In the propensity-matched cohort, both increasing ASA (HR 1.98 95% CI1.57-2.49, P < 0.001) and mGPS (HR 1.20 95% CI1.02-1.41, P = 0.027) were associated with OS independent of age, N stage and adjuvant therapy use; results in the whole cohort were similar. The combination of ASA grade and mGPS was examined with respect to OS in patients with stage II-III CRC (Table 1). In patients with stage II disease, 3-year OS was stratified from 96% (ASA 1, mGPS0) to 67% (ASA 3, mGPS2) ( P < 0.001); in patients with stage II disease, 3-year OS was stratified from 84% to 44% ( P < 0.001). Conclusions: Using a large, prospectively collected dataset of patients undergoing resection of CRC in two countries, the results of the present study confirm the independent prognostic value of measures of comorbidity and systemic inflammation prior to surgery.

Signal transduction and activator of transcription 3 (STAT3), host inflammatory responses and survival of patients with colorectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 606-606
Author(s):  
James Hugh Park ◽  
Donald C. Mcmillan ◽  
Jennifer Clark ◽  
Paul G. Horgan ◽  
Campbell S.D. Roxburgh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Responses ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Lymph Node Involvement ◽  
Clinicopathological Characteristics ◽  
Cancer Specific Survival ◽  
Stat3 Pathway ◽  
Modified Glasgow Prognostic Score ◽  
Inflammatory Status

606 Background: In patients with colorectal cancer (CRC), the local and systemic inflammatory responses (LIR and SIR) are important determinants of disease progression, and may be linked by activation of the IL-6/JAK/STAT3 pathway. The present study examines the associations between STAT3 expression and activation with LIR and SIR of patients undergoing resection of CRC. Methods: Patients with stage I-III CRC who underwent curative resection in a single institution and who were included in a previously constructed tissue microarray were studied. IHC was utilised to examine cytoplasmic total STAT3 and nuclear phosphorylated STAT3Tyr705 (pSTAT3) expression. The relationship between STAT3/pSTAT3 expression and clinicopathological characteristics, LIR (Klintrup-Makinen (KM) grade, CD3+ and CD8+T-cell density) and SIR (modified Glasgow Prognostic Score (mGPS)) and cancer-specific survival (CSS) was examined. Results: 201 patients were included. Cytoplasmic STAT3 expression was associated with nuclear pSTAT3 expression (P= 0.019). Increased cytoplasmic STAT3 expression was associated with high density of T-cells within the intraepithelial compartment (CD3+: low STAT3 – 49% vs. high STAT3 – 29%, P= 0.008; CD8+: low STAT3 – 43% vs. high STAT3 – 20%, P = 0.002) and with an elevated mGPS (mGPS > 1: low STAT3 – 31% vs. high STAT3 – 49%, P= 0.003) but not with any other clinicopathological features. Increased nuclear pSTAT3 expression was associated with younger age and lymph node involvement (P< 0.05) but was not associated with the LIR or SIR. Combined assessment of cytoplasmic STAT3 and nuclear pSTAT3 expression stratified 5-year CSS from 78% (both low) to 50% (both high) (P= 0.006). Conclusions: Activation of the IL-6/JAK/STAT3 pathway may be an important determinant of the LIR and SIR in patients with colorectal cancer. Furthermore, assessment of host inflammatory responses may identify patients likely to benefit from therapies targeting this pathway. Taken together with the results of recent clinical trials, the results of the present study suggest that recruitment of patients into future trials of such agents should be stratified by the inflammatory status of the patient.

Clinical utility of the preoperative Glasgow prognostic score in patients undergoing potentially curative resection for colorectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3611-3611
Author(s):  
Donald C. Mcmillan ◽  
Campbell SD Roxburgh ◽  
Paul G Horgan
Keyword(s):  
Colorectal Cancer ◽  
Clinical Utility ◽  
Curative Resection ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Tnm Stage ◽  
Stage Ii ◽  
Royal Infirmary ◽  
Cancer Specific Survival ◽  
Study Results

3611 Background: There is now good evidence that, in addition to TNM stage, the pre-operative combination of the standardised measurements of C-reactive protein and albumin, the Glasgow Prognostic Score (mGPS) provides valuable prognostic information. The aim of the present study was to examine the clinical application of the pre-operative mGPS in a large mature cohort of patients undergoing potentially curative resection for colorectal cancer. Methods: From a prospectively maintained database, consecutive patients (n= 797) with histologically proven colorectal cancer who were considered to have undergone potentially curative resection between January 1997 and December 2010 in a single surgical unit at the Royal Infirmary, Glasgow were included in the study. Results: Patients with an elevated mGPS were more likely to be older (p<0.001), female (p<0.05), have colonic tumours (<0.001), present as an emergency (p<0.001), had higher TNM stage (p<0.05) and more likely to die of their disease (p<0.01). The median follow-up was 66 months and using 3 year cancer-specific mortality as an endpoint, the area under the receiver operator curve was 0.652 (95% CI, 0.591–0.714; p<0.001) for the mGPS and 0.668 (95% CI, 0.610–0.727; p<0.001) for TNM stage. The cancer-specific survival, at 3 years, varied between 86% and 64% according to the mGPS and between 88% and 72% according to TNM stage. The cancer-specific survival, at 3 years, in patients with a mGPS 0 was 91% and 81% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 1 was 89% and 66% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 2 was 77% and 43% for TNM stage II and III respectively. Conclusions: The results of the present study show the clinical utility of the pre-operative mGPS in predicting cancer specific survival of potentially curative surgery for colorectal cancer.

Evaluation of systemic inflammation-based prognostic scores in patients with advanced colorectal cancer receiving palliative pelvic radiotherapy (RT).

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 558-558
Author(s):  
Ross Dolan ◽  
Nicholas James MacLeod ◽  
Stephen Thomas McSorley ◽  
Paul G. Horgan ◽  
Barry Laird ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systemic Inflammation ◽  
Prognostic Value ◽  
Advanced Colorectal Cancer ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Significant Variable ◽  
Cox Regression Analysis ◽  
Medical Comorbidities ◽  
Male Sex

558 Background: The presence of a systemic inflammatory response (SIR) in patients with advanced cancer is an increasingly recognised prognostic domain and is commonly assessed by the Glasgow Prognostic Score (GPS) and the Neutrophil Lymphocyte Ratio (NLR). However, little work has been carried out to evaluate their role in the field of palliative RT. The aim of the present study was to compare the prognostic value of the GPS and NLR in patients with advanced colorectal cancer receiving palliative pelvic RT. Methods: From a database of all patients undergoing RT in the West of Scotland (2010-2015) patients receiving palliative pelvic RT for colorectal cancer were examined (n = 175). Patients were excluded if they died within 30 days of treatment (n = 15). Demographic data, time from treatment to death/last clinic visit, medical comorbidities, tumour and RT location/dose, CRP, albumin, and differential blood counts were all recorded. GPS, mGPS and NLR were calculated and Cox regression analysis conducted in SPSS. Results: Of the remaining 160 analysed 85 (53%) were male and the median age was 77 (Range: 34-98). The most common clinical indications for palliative radiotherapy were pain (n = 78), bleeding (n = 71) and obstruction/tenesmus (n = 29). Medical comorbidities varied with the most common being hypertension (n- = 75), IHD (n = 36) and diabetes (n = 19). At the time of analysis 130 (81%) of the patients were dead with median survival of 9 months (Range: 1-62 months). On univariate survival analysis Male sex (p = 0.021), GPS (p = 0.015), mGPS (p = 0.028) and NLR ≥ 5 (p = 0.045) but not age > 75 (p = 0.059), Tumour Site (p = 0.637), Performance Status (p = 0.747), ASA (p = 0.525), Delivered Fractions of Radiotherapy (p = 0.062), Dose of RT (p = 0.486) and low Haemoglobin (p = 0.383) were significantly associated with poor survival. On multivariate analysis of the significant variable only male sex (HR: 1.59, 95%CI 1.07-2.36, p = 0.021) and the GPS (HR: 1.47, 95%CI 1.09-1.98, p = 0.011) remained independently associated with survival. Conclusions: In the palliative RT setting systemic inflammation based scores (GPS, mGPS and NLR) had prognostic value and the GPS had independent prognostic value.

The relationship between tumor and host factors and survival in patients undergoing adjuvant chemotherapy for colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 525-525
Author(s):  
James Hugh Park ◽  
Colin H. Richards ◽  
Donald C. Mcmillan ◽  
Paul G. Horgan ◽  
Campbell S. D. Roxburgh
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Tumor Microenvironment ◽  
Inflammatory Responses ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Cancer Specific Survival ◽  
Local Inflammatory Response ◽  
Invasive Margin ◽  
The Relationship

525 Background: The tumor microenvironment and host inflammatory responses are important determinants of outcome in colorectal cancer (CRC), however their impact on survival in patients receiving adjuvant chemotherapy remains unclear. The aim of the present study was to examine the relationship between these factors, clinicopathological characteristics and survival in patients receiving adjuvant chemotherapy for CRC. Methods: 365 patients who had undergone CRC resection at a single institution between 1997-2008 were included; 88 patients subsequently received chemotherapy. Tumor stroma percentage (TSP) and necrosis were assessed on H and E sections and graded as low or high. Local inflammatory response was assessed using the Klintrup-Mäkinen (K-M), Galon and revised Immunoscore (CD45RO+ /CD8+, and CD3+/CD8+at the invasive margin and tumor center, respectively). Systemic inflammation was assessed using modified Glasgow Prognostic Score (mGPS). Results: Patients receiving adjuvant chemotherapy were younger with a lower ASA (both P<0.05), had advanced T- and N-stage (P<0.05 and P<0.001, respectively), poor tumor differentiation (P<0.05), venous invasion (VI) (P<0.01), margin involvement, infiltrative invasive margin (both P<0.05) and high TSP (P<0.01). In those patients who received adjuvant chemotherapy, on multivariate analysis of clinicopathological factors, VI (HR 3.00, 95%CI 1.22-7.37, P=0.017), TSP (HR 3.00, 95%CI 1.26-7.12, P=0.013), K-M score (HR 5.24, 95%CI 1.21-22.68, P=0.027) and mGPS (HR 3.10 95%CI 1.47-6.55, P=0.003) were independently associated with cancer-specific survival. When the interrelationships between factors independently associated with cancer survival were examined, VI, mGPS, K-M score and TSP were independent of each other (all P>0.05). Conclusions: Compared to standard CRC pathological staging, the present results suggest that assessment of both tumor microenvironment and host inflammatory responses may have superior prognostic value compared with TNM in patients receiving adjuvant chemotherapy.

Changes in modified Glasgow prognostic score after neoadjuvant chemotherapy is a prognostic factor in clinical stage II/III esophageal cancer

2016 ◽  
Vol 29 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Yasunori Otowa ◽  
Tetsu Nakamura ◽  
Gosuke Takiguchi ◽  
Ayako Tomono ◽  
Masashi Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Neoadjuvant Chemotherapy ◽  
Squamous Cell ◽  
Prognostic Score ◽  
Clinical Stage ◽  
Glasgow Prognostic Score ◽  
Serum Levels ◽  
Stage Ii ◽  
Modified Glasgow Prognostic Score

Summary The inflammation-based modified Glasgow prognostic score (mGPS) has been shown to be a prognostic factor for esophageal cancer, but its changes in relation to neoadjuvant chemotherapy (NAC) have never been discussed. The purpose of this study was to evaluate the potential prognostic role of mGPS with regard to NAC. mGPS was evaluated on the basis of admission blood samples taken before chemotherapy and before surgery. Patients with elevated C-reactive protein (CRP) serum levels (&gt;10 mg/L) and hypoalbuminemia (&lt;35 g/L) were allocated a score of 2, patients with elevated CRP serum levels without hypoalbuminemia were allocated a score of 1, and patients with normal CRP serum levels with or without hypoalbuminemia were allocated a score of 0. A total of 100 patients with clinical stage II/III squamous cell esophageal cancer, who underwent NAC and esophagectomy between January 2007 and August 2012, were investigated. From the multivariate analysis, the grade of response to chemotherapy and post-NAC mGPS level was found to be independent prognostic factors. The overall survival rate was significantly higher in the conserved mGPS group than in the worse mGPS group (P = 0.030). Changes in mGPS during chemotherapy affected the prognosis of patients, and post-NAC mGPS is an independent prognostic factor in patients with clinical stage II/III thoracic esophageal squamous cell cancer.

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