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Relationship Between Preoperative Comorbidity, Systemic Inflammatory Response, and Survival in Patients Undergoing Curative Resection for Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Besides tumor characteristics, colorectal cancer (CRC) outcomes are also determined by host factors, in particular the systemic inflammatory response. The basis of this relationship with survival is not known; however, systemic inflammation may reflect comorbidity. The present study examines relationships between host factors (including age, comorbidity, deprivation, and systemic inflammation) and survival in CRC.

Methods

A total of 302 patients underwent curative elective CRC resection between 1997 and 2005. Data was collected on patient comorbidity (Charlson Comorbidity Index [CCI], Lee Cardiac Risk Index [LCRI], National Institute on Aging and National Cancer Institute Comorbidity Index [NIA/NCI], and Adult Comorbidity Evaluation-27 [ACE-27]), systemic inflammatory response (Glasgow Prognostic Score [mGPS]), deprivation [Carstairs Deprivation Index], body mass index, and smoking status.

Results

For cancer-specific survival, age (P = 0.047), tumor, node, metastasis system stage (P < 0.001), high-risk Petersen Index (P < 0.001), LCRI (P = 0.021), and mGPS (P < 0.001) were independent factors by multivariate analysis. For overall survival, age (P < 0.001), tumor, node, metastasis system stage (P = 0.001), high-risk Petersen Index (P = 0.002), postoperative infective complications (P = 0.002), ACE-27 (P = 0.008), and mGPS (P < 0.001) were independent factors. Older age related to increasing comorbidity (ACE-27, CCI, LCRI [P < 0.005]) and increased mGPS (P < 0.005). Smoking and deprivation related to increasing comorbidity (P < 0.05). The mGPS was associated with high comorbidity burden assessed with ACE-27 (P = 0.065), CCI (P = 0.016), LCRI (P = 0.095), and NIA/NCI (P = 0.084).

Conclusions

Comorbidity does not fully explain the relationship between the mGPS and cancer-specific survival in CRC patients. Furthermore, comorbidity, in particular that measured by the LCRI, is an important independent indicator of cancer survival.

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Authors and Affiliations

  1. University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland, UK

    C. S. D. Roxburgh MBChB, J. J. Platt MBChB, E. F. Leitch MBChB, P. G. Horgan PhD & D. C. McMillan PhD

  2. University Department of Anaesthesia, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow, Scotland, UK

    J. Kinsella PhD

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  1. C. S. D. Roxburgh MBChB
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  2. J. J. Platt MBChB
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  3. E. F. Leitch MBChB
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  6. D. C. McMillan PhD
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Correspondence to C. S. D. Roxburgh MBChB.

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Roxburgh, C.S.D., Platt, J.J., Leitch, E.F. et al. Relationship Between Preoperative Comorbidity, Systemic Inflammatory Response, and Survival in Patients Undergoing Curative Resection for Colorectal Cancer. Ann Surg Oncol 18, 997–1005 (2011). https://doi.org/10.1245/s10434-010-1410-8

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  • DOI: https://doi.org/10.1245/s10434-010-1410-8

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