Oncology. 2013;84(2):100-7.

Prognostic significance of a systemic inflammatory response in patients undergoing multimodality therapy for advanced colorectal cancer. 

Yasuhiro Inoue,a Takashi Iwata,a Yoshinaga Okugawa,a Aya Kawamoto,a Junichiro Hiro,a Yuji Toiyama,a Koji Tanaka,a Keiichi Uchida,a Yasuhiko Mohri,a Chikao Miki,b and Masato Kusunoki.a

Department of Gastrointestinal and Pediatric Surgery,a Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie, Japan, Department of Surgery,b Ueno Municipal Hospital, Ueno, Mie, Japan

Abstract

Objectives: The inflammation-based Glasgow Prognostic Score (GPS) is associated with outcome in a variety of cancers. This study investigated whether a modified GPS (mGPS) could predict survival in patients undergoing multimodality therapy for advanced colorectal cancer (CRC). Methods: We enrolled 245 patients with advanced CRC who received chemotherapy. The mGPS was recorded prior to first-line chemotherapy, and prior to cytoreductive therapy including secondary surgery and/or radiofrequency ablation. The prognostic significance of the mGPS was analyzed using Kaplan-Meier, univariate, and multivariate analyses. Results: In patients who received chemotherapy alone (n = 163), the mGPS prior to chemotherapy was an independent prognostic indicator of survival (odds ratio [OR] 1.858; 95% confidence interval [CI] 1.213–2.846; P = .0044). In patients who also underwent cytoreductive therapy (n = 82), the mGPS decreased after chemotherapy in 22 patients (27%) and increased in 5 (6%). In these patients, the mGPS prior to cytoreductive therapy was an independent prognostic indicator of survival (OR 3.412; 95% CI 1.198–9.720; P = .0216), but the mGPS prior to chemotherapy was not. Conclusions: The mGPS is an independent prognostic indicator of survival in patients undergoing multimodality therapy for advanced CRC, if recorded at a relevant time point.

Key Words: colorectal cancer; albumin; C-reactive protein; Glasgow Prognostic Score

Copyright © 2012 S. Karger AG, Basel.
PMID: 23147449

Supplement:

GPS is a well-known surrogate marker for response to treatment, and can be used to predict tumor recurrence in a variety of cancers (McMillan et al., 2003, Crozier et al., 2006, Forrest et al., 2003). Our results showed differences in the mGPS of some patients when determined prior to conversion chemotherapy and prior to cytoreductive therapy, with mGPS decreasing in 27% and increasing in 6%.

As the mGPS is simply a marker of inflammation, the reason for the change in mGPS after chemotherapy remains unexplained. Comprehensive cancer treatment including chemotherapy and supportive care might optimize the interaction between tumor-generated and host-induced inflammatory mediators, resulting in a decrease in the mGPS.

The combination of several inflammation-based factors including mGPS might reflect the balance between tumor progression and host-related immunity exactly during systemic cancer chemotherapy.

Contact:

Yasuhiro Inoue, MD,Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan

Tel: +81-59-231-5294; Fax: +81-59-232-6968

E-mail: yasinoue@clin.medic.mie-u.ac.jp

Inoue Yasuhiro- fig1

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