Inflammation-based prognostic scores as indicators to select candidates for primary site resection followed by multimodal therapy among colorectal cancer patients with multiple metastases.

Abstract

BACKGROUND:

Although patients with metastatic colorectal cancer (CRC) are often unable to undergo treatment after resection of primary tumors, identifying such patients before surgery is not easy. In this study, we evaluated the association among clinicopathological findings, survival outcomes, and ability to undergo multimodal therapy after primary tumor resection in patients with Stage IV CRC.

METHODS:

We collected clinicopathological findings and preoperative laboratory data, including carcinoembryonic antigen (CEA) and systemic inflammatory response markers for 92 patients who were treated for Stage IV CRC between 2005 and 2014. We used multivariate analysis on factors that affect prognosis and ability to undergo postoperative treatment.

RESULTS:

Postoperative multimodal therapy improved overall survival (OS) significantly. Among serum markers, elevated CEA, neutrophil-to-lymphocyte ratio, and modified Glasgow prognosis score (mGPS) were significant indicators of shorter OS. In multivariate analysis, low performance status (P = 0.003), undifferentiated histology type (P = 0.019), and elevated mGPS (P = 0.042) were independent predictors of worse prognosis; and older age (P = 0.016), right-sided colon cancer (P = 0.043), and elevated mGPS (P = 0.031) were independent risk factors for difficulty of introducing postoperative multimodal therapy.

CONCLUSIONS:

Preoperative mGPS is a useful objective indicator for CRC patients with multiple metastases who are able to undergo primary site resection followed by postoperative multimodal therapy.

• Authors: Tadanobu Shimura, Yuji Toiyama, Susumu Saigusa, Hiroki Imaoka, Masato Okigami, Hiroyuki Fujikawa, Junichiro Hiro, Minako Kobayashi, Masaki Ohi, Toshimitsu Araki, Yasuhiro Inoue, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki
• Journal: International journal of clinical oncology (Int J Clin Oncol) Vol. 22 Issue 4 Pg. 758-766 (Aug 2017) ISSN: 1437-7772 [Electronic] Japan
• PMID: 28299463 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Biomarkers
• Carcinoembryonic Antigen

Topics

• Aged
• Aged, 80 and over
• Biomarkers (analysis)
• Carcinoembryonic Antigen (blood)
• Colorectal Neoplasms (mortality, pathology, surgery, therapy)
• Combined Modality Therapy
• Female
• Humans
• Inflammation (complications, metabolism)
• Lymphocytes (pathology)
• Male
• Middle Aged
• Multivariate Analysis
• Neutrophils (pathology)
• Prognosis
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Treatment Outcome