The significance of the inter-relationship between tumour and host local/systemic inflammatory responses in primary operable invasive breast cancer is limited. The inter-relationship between the systemic inflammatory response (pre-operative white cell count, C-reactive protein and albumin concentrations), standard clinicopathological factors, tumour T-lymphocytic (CD4 þ and CD8 þ ) and macrophage (CD68 þ ) infiltration, proliferative (Ki-67) index and microvessel density (CD34 þ ) was examined using immunohistochemistry and slide-counting techniques, and their prognostic values were examined in 168 patients with potentially curative resection of early-stage invasive breast cancer. Increased tumour grade and proliferative activity were associated with greater tumour T-lymphocyte (Po0.05) and macrophage (Po0.05) infiltration and microvessel density (Po0.01). The median follow-up of survivors was 72 months. During this period, 31 patients died; 18 died of their cancer. On univariate analysis, increased lymph-node involvement (Po0.01), negative hormonal receptor (Po0.10), lower albumin concentrations (Po0.01), increased tumour proliferation (Po0.05), increased tumour microvessel density (Po0.05), the extent of locoregional control (Po0.0001) and limited systemic treatment (Pp0.01) were associated with cancer-specific survival. On multivariate analysis of these significant covariates, albumin (HR 4.77, 95% CI 1.35 -16.85, P ¼ 0.015), locoregional treatment (HR 3.64, 95% CI 1.04 -12.72, P ¼ 0.043) and systemic treatment (HR 2.29, 95% CI 1.23 -4.27, P ¼ 0.009) were significant independent predictors of cancer-specific survival. Among tumour-based inflammatory factors, only tumour microvessel density (Po0.05) was independently associated with poorer cancerspecific survival. The host inflammatory responses are closely associated with poor tumour differentiation, proliferation and malignant disease progression in breast cancer.

The relationship between tumour stage, grade, elevated C-reactive protein concentration (o10/410 mg l À1 ), adjuvant therapy and survival was examined in patients with biopsy proven bladder cancer (n ¼ 105). On multivariate analysis stage (HR 3.37, 95% CI 1.37 -8.29, P ¼ 0.008), grade (HR 2.01, 95% CI 1.14 -3.57, P ¼ 0.017) and preoperative C-reactive protein (HR 3.31, 95% CI 1.09 -10.09, P ¼ 0.035) were independently associated with cancer-specific survival.

The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration, and COX-2 expression and survival was examined in patients with transitional cell carcinoma of the urinary bladder (n ¼ 103). Sixty-one patients had superficial disease and 42 patients had invasive disease. Cancer-specific survival was shorter in those patients with invasive compared with superficial bladder cancer (Po0.001). On univariate analysis, stratified by stage, increased Ki-67 labelling index (Po0.05), increased COX-2 expression (Po0.05), C-reactive protein (Po0.05) and adjuvant therapy (Po0.01) were associated with poorer cancer-specific survival. On multivariate analysis of these significant factors, stratified by stage, only C-reactive protein (HR 2.89, 95% CI 1.42 -5.91, P ¼ 0.004) and adjuvant therapy (HR 0.29, 95% CI 0.14 -0.62, P ¼ 0.001) were independently associated with poorer cancer-specific survival. These results would suggest that tumour-based factors such as grade, COX-2 expression or T-lymphocytic infiltration are subordinate to systemic factors such as C-reactive protein in determining survival in patients with transitional cell carcinoma of the urinary bladder.

Introduction: To examine the role of inflammation in bladder cancer, we assessed the relationship between a systemic inflammation prognostic score (modified Glasgow Prognostic Score, mGPS), the tumor inflammatory cell infiltrate as measured by the Klintrup-Makinen score and tumor necrosis with cancer specific survival in patients with bladder cancer. Materials and Methods: The cohort consisted of 68 bladder cancer patients, 47 with localised disease and 21 with muscle invasive disease. The mGPS response was constructed by measuring C-reactive protein and albumin concentrations and the Klintrup-Makinen score was evaluated histologically for the local inflammatory response. Pathological parameters such as grade, T stage and tumor necrosis were also assessed. Results: Median follow was 47 months and 24 patients died of their disease. On univariate analysis, T stage (p < 0.001), grade (p < 0.001) and mGPS (p = 0.002) were significant predictors of cancer specific survival. On multivariate analysis, T stage (hazard ratio 5.98, 95% confidence interval 3.18–11.24, p < 0.001) and mGPS (hazard ratio 1.78, 95% confidence interval 1.09–2.9, p = 0.02) were significant independent predictors of cancer specific survival. Conclusion: A preoperative systemic inflammatory response is an independent predictor of poor cancer specific survival in patients with bladder cancer.