International Journal of Clinical Oncology

, Volume 22, Issue 4, pp 758–766

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

  • 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
Original Article



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.


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.


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.


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.


Colorectal cancer Stage IV Primary tumor resection modified Glasgow prognostic score 

Supplementary material

10147_2017_1113_MOESM1_ESM.ppt (194 kb)
Supplemental Figure 1 Modified GPS score against histological differentiation. The mGPS2 group had a significantly higher percentage of poorly differentiated histological type (7/20, 35%) than the mGPS0/1 group (6/72, 8.3%, P = 0.0054). Supplemental Figure 2 Histological differentiation against NLR values. The poor histology group had significantly higher median preoperative NLR (5.53, range 0.96–17.71) than the well/moderate histology group (2.98, range 0.57–30.13; P = 0.0332). Supplemental Figure 3 Patient age in relation to whether or not they underwent postoperative treatment. Median age in the untreated group (75 years; range 59–90 years) was significantly older than in the treated group (63 years, range 31–84 years; P = 0.0002) (PPT 194 kb)
10147_2017_1113_MOESM2_ESM.docx (23 kb)
Supplementary material 2 (DOCX 23 kb)


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Tadanobu Shimura
    • 1
  • Yuji Toiyama
    • 1
  • Susumu Saigusa
    • 1
  • Hiroki Imaoka
    • 1
  • Masato Okigami
    • 1
  • Hiroyuki Fujikawa
    • 1
  • Junichiro Hiro
    • 1
  • Minako Kobayashi
    • 1
  • Masaki Ohi
    • 1
  • Toshimitsu Araki
    • 1
  • Yasuhiro Inoue
    • 1
  • Keiichi Uchida
    • 1
  • Yasuhiko Mohri
    • 1
  • Masato Kusunoki
    • 1
  1. 1.Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of MedicineMie UniversityMieJapan

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