Abstract
Background
Tumor-associated systemic inflammatory response has been correlated with prognosis. Our aim was to analyze the utility of inflammation-based prognostic scores for prognostication and patient selection for cytoreduction and perioperative intraperitoneal chemotherapy (POIC) in patients diagnosed with peritoneal metastasis of colonic origin.
Methods
A retrospective analysis of a prospectively maintained database for all patients treated for peritoneal metastasis of colonic origin from February 2001 to April 2015. Inflammation-based prognostic scores including neutrophil–lymphocyte ratio, platelet–lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (ONI) were calculated.
Results
Of 123 patients, 70 (56.9%) were men and 53 (43.1%) were women. Mean age at diagnosis was 49.9 years. Significant prognosticators in univariate analysis included intraoperative peritoneal cancer index (p < 0.000), tumor marker CA19-9 (p < 0.000), PLR (p = 0.020), POIC regimen (p < 0.003), and completeness of cytoreduction (p < 0.000). Multivariate Cox analysis identified CA19-9 (hazard ratio [HR] 1.0; 95% confidence interval [CI] 1.00–1.01, p = 0.031), ONI (HR 0.86; 95% CI 0.79–0.94, p < 0.000), PLR (HR 1.0; 95% CI 0.90–1.01, p = 0.041), incompleteness of cytoreduction CC2 and CC3, and mucinous adenocarcinoma histology as significant independent prognosticators.
Conclusions
The inflammation-based prognostic scores PLR and ONI and tumor marker CA19-9 are significant prognosticators of survival. They are useful in patient selection and prognostication for cytoreductive surgery and POIC in patients with peritoneal carcinomatosis of colonic origin.
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References
Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome study. Eur J Cancer. 2011;47:2633–41.
Messager M, Neofytou K, Chaudry MA, Allum WH. Prognostic impact of preoperative platelets to lymphocytes ratio (PLR) on survival for oesophageal and junctional carcinoma treated with neoadjuvant chemotherapy: a retrospective monocentric study on 153 patients. Eur J Surg Oncol. 2015;41:1316–23.
Demaria S, Pikarsky E, Karin M, et al. Cancer and inflammation: promise for biologic therapy. J Immunother. 2010;33:335–51.
Dinarello CA. The paradox of pro-inflammatory cytokines in cancer. Cancer Metastasis Rev. 2006;25:307–13.
Nozoe T, Saeki H, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg. 2001;182:197–201.
McKeown DJ, Brown DJ, Kelly A, Wallace AM, McMillan DC. The relationship between circulating concentrations of C-reactive protein, inflammatory cytokines and cytokine receptors in patients with non-small-cell lung cancer. Br J Cancer. 2004;91:1993–5.
Hilmy M, Bartlett JM, Underwood MA, McMillan DC. The relationship between the systemic inflammatory response and survival in patients with transitional cell carcinoma of the urinary bladder. Br J Cancer. 2005;92:625–7.
Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer. 2005;92:21–3.
Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.
Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144:646–74.
Ding PR, An X, Zhang RX, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer. Int J Colorectal Dis. 2010;25:1427–33.
Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288–95.
Hung HY, Chen JS, Yeh CY, et al. Effect of preoperative neutrophil–lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis. 2011;26:1059–65.
Chiang SF, Hung HY, Tang R, et al. Can neutrophil-to-lymphocyte ratio predict the survival of colorectal cancer patients who have received curative surgery electively? Int J Colorectal Dis. 2012;27:1347–57.
Kaneko M, Nozawa H, Sasaki K, et al. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in advanced colorectal cancer patients receiving oxaliplatin-based chemotherapy. Oncology. 2012;82:261–8.
Malietzis G, Giacometti M, Askari A, et al. A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery. Ann Surg. 2014;260:287–92.
Zhou X, Du Y, Huang Z, et al. Prognostic value of PLR in various cancers: a meta-analysis. PLoS ONE. 2014;9:e101119.
Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.
Tan D, Fu Y, Su Q, et al. Prognostic role of platelet–lymphocyte ratio in colorectal cancer. Medicine. 2016;95:e3837.
Peng H, Lin K, He B, et al. Platelet-to-lymphocyte ratio could be a promising prognostic biomarker for survival of colorectal cancer: a systematic review and meta-analysis. FEBS Open Bio. 2016;6:742–50.
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil–lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–4.
Jian-hui C, Iskandar EA, Cai S, et al. Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer: a large cohort study in a single Chinese institution. Tumour Biol. 2016;37:3277–83.
Vukobrat-Bijedic Z, Husic-Selimovic A, Sofic A, et al. Cancer antigens (CEA and CA 19-9) as markers of advanced stage of colorectal carcinoma. Med Arch. 2013;67:397–401.
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Ihemelandu, C. Inflammation-Based Prognostic Scores: Utility in Prognostication and Patient Selection for Cytoreduction and Perioperative Intraperitoneal Chemotherapy in Patients with Peritoneal Metastasis of Colonic Origin. Ann Surg Oncol 24, 884–889 (2017). https://doi.org/10.1245/s10434-016-5693-2
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DOI: https://doi.org/10.1245/s10434-016-5693-2