Role of Systemic Inflammatory Response in Predicting Survival in Patients with Primary Operable Cancer

Abstract

Disease progression in cancer is dependent on the complex interaction between the tumor and the host inflammatory response. There is substantial evidence in advanced cancer that host factors, such as weight loss, poor performance status and the host systemic inflammatory response, are linked, and the latter is an important tumor-stage-independent predictor of outcome. Indeed, the systemic inflammatory response, as evidenced by an elevated level of C-reactive protein, is now included in the definition of cancer cachexia. This review examines the role of the systemic inflammatory response in predicting survival in patients with primary operable cancer. Approximately 80 studies have evaluated the role of the systemic inflammatory response using biochemical or hematological markers, such as elevated C-reactive protein levels, hypoalbuminemia or increased white cell, neutrophil and platelet counts. Combinations of such factors have been used to derive simple inflammation-based prognostic scores, such as the Glasgow Prognostic Score, the neutrophil:lymphocyte ratio and the platelet:lymphocyte ratio. This review demonstrates that there is now good evidence that preoperative measures of the systemic inflammatory response predict cancer survival, independent of tumor stage, in primary operable cancer. The evidence is particularly robust in colorectal (including liver metastases), gastro-esophageal and renal cancers. As described in this article, measurement of the systemic inflammatory response is simple, reliable and can be clinically incorporated into current staging algorithms. This will provide the clinician with a better prediction of outcome, and therefore better treatment allocation in patients with primary operable cancer. Furthermore, systemic inflammation-based markers and prognostic scores not only identify patients at risk, but also provide well-defined therapeutic targets for future clinical trials.

Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors

“…[16] This inflammatory response reflects a non-specific response to tumor hypoxia, tissue injury and necrosis. [15][16][17] to explain neutrophilia include release of granulocyte-colony stimulating factor (G-CSF) by tumor cells, and cancer inflammation through release of interleukin (IL)-1, IL-6 and tumor necrosis factor-alpha (TNF-α). [18,19] Neutrophils are recruited by (G-CSF), which is associated with tumor progression.…”

Optimization of the systemic inflammation‐based Glasgow Prognostic Score

“…6 More recently, there has been renewed interest in the beneficial impact of an activated local inflammatory response on the outcome of patients with cancer. 22 Therefore, the relation between the systemic and local inflammatory responses is likely to be of considerable and increasing interest in the future.…”

“…4,5 In particular, the systemic inflammatory response, as evidence by elevated C-reactive protein levels, has been shown to be associated with reduced survival in several common cancers. 6 It is also of interest that acute-phase protein markers of the systemic inflammatory response, namely C-reactive protein and albumin using standard thresholds (> 10 mg/L for C-reactive protein and < 35 g/L for albumin), have been combined to form a cumulative inflammation-based prognostic score termed the Glasgow Prognostic Score (GPS) ( Table 1). 7,8 This was subsequently refined to form the modified Glasgow Prognostic Score (mGPS) ( Table 1) 8 when, in patients with primary operable colorectal cancer, hypoalbuminemia alone was found to have similar prognostic value as a GPS of 0.…”

Pretreatment Neutrophil/Lymphocyte Ratio as a Prognostic Aid in Colorectal Cancer

“…It is now becoming clear that the tumor microenvironment, which is largely orchestrated by inflammatory cells, is an essential participant in the neoplastic process, promoting proliferation, survival, and migration. For this reason many studies have been focused on the evidence of the role of inflammation in carcinogenesis recently (Waldner et al, 2006, Roxburgh et al, 2010Unal et al, 2013). Generally, studies described that lymphopenia means an impaired cell-mediated immunity, while neutrophilia is linked response to systemic inflammation (Zahorec et al, 2001).…”