Systemic Inflammation and Outcome in 2295 Patients with Stage I–III Colorectal Cancer from Scotland and Norway: First Results from the ScotScan Colorectal Cancer Group

Abstract

Background. Systemic inflammatory response (SIR) is an adverse prognostic marker in colorectal cancer (CRC) patients. The ScotScan Colorectal Cancer Group was established to examine how markers of the SIR differ between populations and may be utilised to guide prognosis. Patients and Methods. Patients undergoing resection of stage I-III CRC from two prospective datasets in Scotland and Norway were included. The relationship between the modified Glasgow Prognostic Score (mGPS; combination of C-reactive protein and albumin) and overall survival (OS) was examined. The relationship between OS, adjuvant chemotherapy regime and mGPS was examined in patients with stage III colon cancer. Results. A total of 2295 patients were included. Patients from Scotland were more inflamed despite controlling for associated characteristics using multivariate logistic regression or propensity score matching (OR 2.82, 95% CI 1.98-4.01, p \ 0.001). mGPS had similar independent prognostic value in both cohorts (Scotland: HR 1.27, 95% CI 1.12-1.45; Norway: HR 1.23, 95% CI 1.01-1.49) and stratified survival independent of TNM group in the whole cohort. In patients with stage III colon cancer receiving adjuvant therapy, there appeared to be a survival benefit in systemically inflamed patients receiving oxaliplatin but not single-agent 5-fluorouracil or capecitabine. Conclusions. The SIR differs between populations from different countries; however prognostic value remains similar. The present study strongly supports the routine reporting of the mGPS in patients with CRC.

Prognostic Value of Pretreated Blood Inflammatory Markers in Patients with Bone Sarcoma: A Meta-Analysis

“…Accumulating evidence has revealed that cancer-associated systematic inflammation might play crucial roles in the genesis and progression of tumors [ 7 – 10 ]. The inflammatory response is known to be reflected by many blood biomarkers, including neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR).…”

Sex Disparities in Vitamin D Status and the Impact on Systemic Inflammation and Survival in Rectal Cancer

“…A unique discovery from our investigations was that sex differences associated with the vitamin D status also pertained to the modes of systemic inflammation. The clinical syndrome of SIR, defined by elevated circulating white blood cell-and thrombocyte counts and acutephase proteins such as C-reactive protein [35], has been consistently observed to confer poor outcome [36], as shown valid in all stages of CRC [8,9]. In the present study population, the classic SIR was related to low vitamin D in the male patients, also when the associations were compared by entering sex and 25(OH) D level as interacting factors in the statistical model.…”

“…A wide range of molecular components, many of which are reflected in the systemic circulation, are involved in cancer-related inflammation [7]. The systemic inflammatory response (SIR) as such is an adverse prognostic marker in all stages of CRC [8,9]. Furthermore, it is notable that both incidence and mortality rates of rectal cancer are significantly higher in men than in women [10,11], which might relate to modifiable lifestyle factors with different impact in the two sexes [12].…”

Sex disparities in vitamin D status and the impact on systemic inflammation and survival in rectal cancer

“…A unique discovery from our investigations was that sex differences associated with the vitamin D status also pertained to the modes of systemic inflammation. The clinical syndrome of SIR, defined by elevated circulating white blood cell- and thrombocyte counts and acute-phase proteins such as C-reactive protein [ 35 ], has been consistently observed to confer poor outcome [ 36 ], as shown valid in all stages of CRC [ 8 , 9 ]. In the present study population, the classic SIR was related to low vitamin D in the male patients, also when the associations were compared by entering sex and 25(OH) D level as interacting factors in the statistical model.…”

“…A wide range of molecular components, many of which are reflected in the systemic circulation, are involved in cancer-related inflammation [ 7 ]. The systemic inflammatory response (SIR) as such is an adverse prognostic marker in all stages of CRC [ 8 , 9 ]. Furthermore, it is notable that both incidence and mortality rates of rectal cancer are significantly higher in men than in women [ 10 , 11 ], which might relate to modifiable lifestyle factors with different impact in the two sexes [ 12 ].…”