Systemic inflammation, adjuvant chemotherapy, and survival in stage III colorectal cancer: Results from the ScotScan Colorectal Cancer Collaborative.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 228-228
Author(s):  
James Hugh Park ◽  
Anniken Jorlo Fuglestad ◽  
Anne Helene Kostner ◽  
Agata Oliwa ◽  
Campbell SD Roxburgh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Predictive Biomarker ◽  
Stage Iii ◽  
C Reactive Protein ◽  
Cancer Specific Survival ◽  
Reactive Protein ◽  
Chemotherapy Regime ◽  
The Relationship

228 Background: The systemic inflammatory response (SIR) is a poor prognostic marker in patients with colorectal cancer (CRC), and predicts poor outcome following adjuvant chemotherapy. Whether this may be influenced by chemotherapy regime is not known. The present study examined the relationship between the pre-operative SIR, adjuvant therapy regime, and survival of patients with stage III CRC in the ScotScan cohort. Methods: Patients with stage III CRC in Scotland (1997-2015, n= 317) and Norway (2000-17, n= 312) were included. The pre-operative SIR was measured using C-reactive protein (CRP≤10mg/L or > 10mg/L). Adjuvant status was categorised as none, 5-fluorouracil-only (5FU or capecitabine), or oxaliplatin-combination (Ox). Relationship with 3 year overall (OS) and cancer-specific survival (CSS) was examined. Results: Rates of Ox were comparable between cohorts (Scotland – 26% vs. Norway 28%), although more patients from Norway received single 5FU (4% vs. 19%, P= 0.005). 36% of each cohort were systemically inflamed. Ox was associated with superior OS (90%) and CSS (92%) when compared to 5FU (77% and 84%) and no therapy (61% and 72%, both P< 0.001). Stratified by SIR, patients with CRP≤10mg/L receiving Ox or 5FU had comparable 3yr OS greater than those receiving none (90% vs. 88% vs. 67%), whereas those with CRP > 10mg/L receiving Ox had superior survival than those receiving 5FU or no therapy (89% vs. 64% vs. 53%, P-for interaction = 0.101). Results were similar for CSS (CRP≤10mg/L: 91% vs. 94% vs. 79%; CRP > 10mg/L: 94% vs. 72% vs. 62%, P-for interaction= 0.01). Although patients receiving Ox were younger and less comorbid, both use of Ox and SIR remained independently associated with OS and CSS. Conclusions: Although selection bias in the choice of adjuvant therapy may confound analysis, this study suggests the SIR may aid in determining response to adjuvant therapy. Whereas non-inflamed patients with stage III CRC may benefit from single 5FU, those with an elevated SIR may benefit greater from more intensive, Ox-based regimes. These results remain to be validated, however support the use of the SIR as a prognostic and predictive biomarker in patients with stage III CRC.

scholarly journals The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0167967 ◽  
Author(s):  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Yorihisa Sumida ◽  
Shigekazu Hidaka ◽  
Terumitsu Sawai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Stage Iii ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Colorectal Cancer Patients

The relationship between serum and tumoral CRP, Akt, MAPK, and survival in patients undergoing potentially curative resection for colorectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14110-e14110
Author(s):  
Arfon Powell ◽  
Scott Shepherd ◽  
Clare Orange ◽  
Donald C. Mcmillan ◽  
Paul G Horgan ◽  
...  
Keyword(s):  
Map Kinase ◽  
Patient Survival ◽  
C Reactive Protein ◽  
Tumour Heterogeneity ◽  
Cancer Specific Survival ◽  
Colorectal Tumour ◽  
Reactive Protein ◽  
Membrane Bound ◽  
Serum Crp ◽  
The Relationship

e14110 Background: Serum CRP was previously reported in myeloma to activate membrane bound Fcγ receptors which in turn activated Akt, and MAP kinase and inhibited caspase cascade activation resulting in increased tumour cell proliferation and inhibition of apoptosis. This study investigated the hypothesis that serum C-reactive protein (CRP) may activate signalling pathways in colorectal tumour cells. Methods: A cohort of 147 colorectal tumours was established and immunohistochemistry performed to assess protein expression of CRP, MAP kinase and Akt phosphorylated at serine 473 (pAkt). In addition, reverse transcriptase PCR for CRP mRNA expression was performed on 31 malignant colorectal specimens, 20 non-malignant colorectal specimens and 30 liver specimens. Results: No association between patient survival and tumour expression of CRP, pAkt and MAPK was observed, but serum CRP was independently associated with cancer-specific survival (p<0.001). When analysed according to tumour site, cytoplasmic CRP expression was associated with cancer specific survival in left sided tumours (p=0.022) and cytoplasmic pAkt was associated with cancer specific survival (p=0.029) in rectal tumours. No correlations were observed between serum CRP and tumour expression of CRP, pAkt and MAPK in the cohort as a whole or when subdivided by site. Conclusions: No link was established between serum CRP and signalling within the tumour. However, our results do support the concept of colorectal tumour heterogeneity, as different proteins were associated with patient survival depending on site. Further work is therefore required to elucidate the mechanisms underlying colorectal development and progression in tumour subtypes.

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.

Chemotherapy dose reductions in obese patients undergoing adjuvant chemotherapy for colorectal cancer: secondary analyses of trial data and the Greater Manchester and Cheshire Cancer Network Audit.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 763-763
Author(s):  
Prakhar Srivastava ◽  
Lee Malcolmson ◽  
Mark P. Saunders ◽  
Andrew Renehan
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Stage Iv ◽  
Obese Patients ◽  
Cancer Specific Survival ◽  
Stage Iv Cancer ◽  
Cancer Network ◽  
The Relationship ◽  
Dose Reductions

763 Background: In patients with stage II/III colorectal cancer receiving adjuvant chemotherapy, doses are calculated using body surface area (BSA) but often capped at BSA > 2.0. Dose capping might be a mechanism of reported poorer survival in obese patients. We aimed to investigate the different dosing schedules across BMI categories, using trial and ‘real world’ audit datasets, and determine its impact upon overall survival. Methods: Data was accessed for 1122 patients from the control arm of the MOSAIC trial (accessed via the Data Project Sphere) and 327 patients from the Greater Manchester and Cheshire Cancer Network (GMCCN) audit. Pearson’s χ2 and correlation coefficient were used to assess the relationship between BMI (expressed as normal, overweight and obese: and as continuous, respectively) and dose reductions. A multiple logistic regression model was constructed to compare the odds of receiving dose reductions in each BMI category. 4-year overall survival was calculated for each BMI category and dose status. Results: In MOSAIC, there were increasing dose reductions by BMI category: normal, 3%; overweight, 5%; and obese, 11%, with similar patterns in the GMCCN OxMdG group. Obese patients in MOSAIC and the GMCCN OxMdG group had 3- and 12-fold higher odds (OR = 3.4 and 12.5, CI = 1.6-7.0 and 2.0-78.1), respectively, of receiving dose reductions. However, these differences did not translate to differences in overall survival by BMI category or dose status. Conclusions: In our investigated datasets, there appears to be a relationship between increasing BMI and dose reductions, though it is modest and does not manifest as a detrimental influence on overall survival. Our findings agreed with other studies performed using stage IV cancer patients, although the relationship between increasing BMI and dose reductions is more prominent in patients with metastatic disease. Investigating other outcome measures such as cancer-specific survival and chemotherapy related toxicity is required for clarity.

scholarly journals Clinical impact of C-reactive protein to albumin ratio of the 7th postoperative day on prognosis after laparoscopic colorectal cancer surgery

2022 ◽  
Author(s):  
Masahiro Kataoka ◽  
Kuniyuki Gomi ◽  
Ken Ichioka ◽  
Takuya Iguchi ◽  
Tomoki Shirota ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factor ◽  
Radical Resection ◽  
Significant Prognostic Factor ◽  
C Reactive Protein ◽  
Colorectal Cancer Surgery ◽  
Free Survival ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
The Relationship

Abstract Background/Aim: C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, first postoperative day (POD1), and seventh postoperative day (POD7) CARs and the prognosis of patients with colorectal cancer (CRC). Patients and Methods: 320 patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into two groups, high CAR and low CAR, based on preoperative, POD1, and POD7 CARs. The relapse-free survival (RFS) and overall survival (OS) were compared between groups using propensity score matching. Results The high CAR group had a significantly worse RFS and OS (n=72/group, RFS: p<0.001; OS: p=0.002) at POD7 than those in the low CAR group. However, in preoperative and POD1 analysis, no differences were observed. Conclusion In patients with colorectal cancer, CAR of POD7 was a significant prognostic factor.

scholarly journals Postoperative, but not preoperative, inflammation-based prognostic markers are prognostic factors in stage III colorectal cancer patients

2020 ◽  
Author(s):  
Kohei Yasui ◽  
Dai Shida ◽  
Yuya Nakamura ◽  
Yuka Ahiko ◽  
Shunsuke Tsukamoto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Markers ◽  
Normal Group ◽  
Stage Iii ◽  
C Reactive Protein ◽  
Protein Ratio ◽  
Reactive Protein ◽  
Lymphocyte To Monocyte Ratio ◽  
Clinicopathologic Factors ◽  
Inflammatory State

Abstract Background Recent evidence suggests that both preoperative and postoperative inflammation-based prognostic markers are useful for predicting the survival of colorectal cancer (CRC) patients. However, associations between longitudinal changes in inflammation-based prognostic markers and prognosis are controversial. Methods The subjects of this study were 568 patients with stage III CRC between 2008 and 2014. Preoperative and postoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein/albumin ratio (CAR) and lymphocyte-to-C-reactive protein ratio (LCR) were calculated to assess the inflammatory state of subjects. Subjects were stratified into three groups for each marker: preoperatively low inflammatory state (normal group), preoperatively high but postoperatively low inflammatory state (normalised group) and persistently high inflammatory state (elevated group). Multivariable analyses for overall survival (OS) and recurrence-free survival (RFS) were performed to adjust for well-established clinicopathologic factors. Results For all assessed markers, the normalised group had a significantly better prognosis than the elevated group and a similar prognosis as the normal group for both OS and RFS. Conclusions Postoperative, but not preoperative, inflammation-based prognostic markers more accurately predict OS and RFS in patients with stage III CRC.

Early liver metastases after “failure” of adjuvant chemotherapy for stage III colorectal cancer: is there a role for additional adjuvant therapy?

HPB ◽  
2020 ◽  
Author(s):  
Thomas Boerner ◽  
Constantinos Zambirinis ◽  
Johan Gagnière ◽  
Joanne F. Chou ◽  
Mithat Gonen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Liver Metastases ◽  
Stage Iii
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