University Department of Surgery, Faculty of Medicine - University of Glasgow, Glasgow, UK.
Future Oncol. 2010 Jan;6(1):149-63. doi: 10.2217/fon.09.136.
Disease progression in cancer is dependent on the complex interaction between the tumor and the host inflammatory response. There is substantial evidence in advanced cancer that host factors, such as weight loss, poor performance status and the host systemic inflammatory response, are linked, and the latter is an important tumor-stage-independent predictor of outcome. Indeed, the systemic inflammatory response, as evidenced by an elevated level of C-reactive protein, is now included in the definition of cancer cachexia. This review examines the role of the systemic inflammatory response in predicting survival in patients with primary operable cancer. Approximately 80 studies have evaluated the role of the systemic inflammatory response using biochemical or hematological markers, such as elevated C-reactive protein levels, hypoalbuminemia or increased white cell, neutrophil and platelet counts. Combinations of such factors have been used to derive simple inflammation-based prognostic scores, such as the Glasgow Prognostic Score, the neutrophil:lymphocyte ratio and the platelet:lymphocyte ratio. This review demonstrates that there is now good evidence that preoperative measures of the systemic inflammatory response predict cancer survival, independent of tumor stage, in primary operable cancer. The evidence is particularly robust in colorectal (including liver metastases), gastro-esophageal and renal cancers. As described in this article, measurement of the systemic inflammatory response is simple, reliable and can be clinically incorporated into current staging algorithms. This will provide the clinician with a better prediction of outcome, and therefore better treatment allocation in patients with primary operable cancer. Furthermore, systemic inflammation-based markers and prognostic scores not only identify patients at risk, but also provide well-defined therapeutic targets for future clinical trials.
癌症的疾病进展取决于肿瘤与宿主炎症反应之间的复杂相互作用。在晚期癌症中，有大量证据表明宿主因素，如体重减轻、表现状态差和宿主全身炎症反应等因素之间存在关联，后者是肿瘤分期独立的预后重要预测因素。事实上，全身炎症反应，如 C 反应蛋白水平升高，现在已被纳入癌症恶病质的定义中。
本综述检查了全身炎症反应在预测原发性可手术癌症患者生存中的作用。大约有 80 项研究使用生化或血液学标志物（如 C 反应蛋白水平升高、低白蛋白血症或白细胞、中性粒细胞和血小板计数增加）评估了全身炎症反应的作用。这些因素的组合已被用于得出简单的基于炎症的预后评分，如格拉斯哥预后评分、中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值。
本综述表明，现在有充分的证据表明，术前全身炎症反应的测量可预测原发性可手术癌症的癌症生存，而与肿瘤分期无关。在结直肠癌（包括肝转移）、胃食管和肾癌中，证据尤其可靠。
如本文所述，全身炎症反应的测量简单、可靠，可以临床纳入当前的分期算法。这将为临床医生提供更好的预后预测，从而更好地为原发性可手术癌症患者分配治疗。此外，基于全身炎症的标志物和预后评分不仅可以识别风险患者，还为未来的临床试验提供了明确的治疗靶点。
