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Molecular Diagnostics

The prognostic value of combined measures of the systemic inflammatory response in patients with colon cancer: an analysis of 1700 patients

British Journal of Cancer volume 124, pages 1828–1835 (2021)Cite this article

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Abstract

Background

The pre-operative systemic inflammatory response (SIR) measured using an acute-phase-protein-based score (modified Glasgow Prognostic Score (mGPS)) or the differential white cell count (neutrophil–lymphocyte ratio (NLR)) demonstrates prognostic significance following curative resection of colon cancer. We investigate the complementary use of both measures to better stratify outcomes.

Methods

The effect on survival of mGPS and NLR was examined using uni/multivariate analysis (UVA/MVA) in patients undergoing curative surgery for colon cancer. The synergistic effect of these scores in predicting OS/CSS was examined using a Systemic Inflammatory Grade (SIG).

Results

One thousand seven hundred and eight patients with TNM-I–III colon cancer were included. On MVA both mGPS and NLR were significant for OS (HR 1.16/1.21, respectively). Three-year survival stratified by mGPS was 83–58%(TNM-I–III), 87–65%(TNM-II) and 75–49%(TNM-III), and by NLR was 84–62%(TNM-I–III), 88–69%(TNM-II) and 77-49%(TNM-III). When mGPS and NLR were combined to form an overall SIG 0/1/2/3/4, this stratified 3-year OS 88%/84%/76%/65%/60% and CSS 93%/90%/82%/73%/70%, respectively (both p < 0.001). SIG stratified OS 93–68%/82–48% and CSS 97–80%/86–58% in TNM Stage II/III disease, respectively (all p < 0.001).

Conclusions

The present study shows that the pre-operative SIR in patients undergoing curative surgery for colon cancer is best measured using a SIG utilising mGPS and NLR.

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Fig. 1: Case selection.
Fig. 2: Overall survival stratified by Systemic Inflammatory Grade.

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Authors and Affiliations

  1. Academic Unit of Surgery—Glasgow Royal Infirmary, Glasgow, UK

    Allan M. Golder, Donald C. McMillan, James H. Park, David Mansouri, Paul G. Horgan & Campbell S. Roxburgh

Authors
  1. Allan M. Golder
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  2. Donald C. McMillan
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  3. James H. Park
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  4. David Mansouri
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  5. Paul G. Horgan
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  6. Campbell S. Roxburgh
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Contributions

A.G.—designing the work, acquiring data, data interpretation and drafting the manuscript. D.C.M.M.—conceiving and designing the work, interpreting the results and revising the manuscript. J-.P.—interpreting the results and revising the manuscript. D.M.—interpreting the results and revising the manuscript. P.H.—interpreting the results and revising the manuscript. C.R.—interpreting the results and revising the manuscript. All authors have approved the final version of this work and agree to be accountable for all aspects of this work.

Corresponding author

Correspondence to Allan M. Golder.

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Ethical approval was granted for this project from the Public Benefit and Privacy Panel (NHS Scotland) for Health and Social Care (PBPP) and Caldicott Guardian Approval.

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Data are available on request.

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The authors declare no competing interests.

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Golder, A.M., McMillan, D.C., Park, J.H. et al. The prognostic value of combined measures of the systemic inflammatory response in patients with colon cancer: an analysis of 1700 patients. Br J Cancer 124, 1828–1835 (2021). https://doi.org/10.1038/s41416-021-01308-x

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