Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland.
Int J Colorectal Dis. 2019 Jun;34(6):1069-1078. doi: 10.1007/s00384-019-03274-6. Epub 2019 Apr 16.
A variety of inflammatory scoring systems and their prognostic value have been reported in many solid organ cancers. This study aimed to examine the association between the systemic and local inflammatory responses, and oncological outcomes in patients undergoing elective surgery for mismatch repair-deficient (dMMR) phenotype colorectal cancer (CRC).
Consecutive patients undergoing resection for dMMR CRC were identified from a prospectively maintained database and compared with a cohort of patients with proficient mismatch repair system tumours. Systemic inflammatory response was assessed by the modified Glasgow prognostic score (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, lymphocyte-monocyte ratio, C-reactive protein/albumin ratio, prognostic index and prognostic nutritional index. Local inflammatory response was defined by the presence of tumour infiltrating lymphocytes, tumour infiltrating neutrophils, plasma cells or macrophages at the invasive front. The inflammatory infiltrate was assessed using the Klintrup-Mäkinen (KM) score.
On univariable analysis, preoperative NLR ≥ 5 (hazard ratio [HR] 2.5; 95% confidence interval [CI] 1.25-5.19; p = 0.007) and mGPS (HR 1.6; 95% CI 1.1-2.6; p = 0.03) predicted worse overall survival, but only NLR was associated with greater recurrence (HR 3.6; 95% CI 1.5-8.8; p = 0.004). Increased local inflammatory response, as measured by KM score (HR 0.31; 95% CI 0.1-0.7; p = 0.009) and the presence of macrophages in the peritumoral infiltrate (HR 0.17; 95% CI 0.07-0.3; p < 0.001), was associated with better outcomes. NLR was the only independent prognostic factor of overall and disease-free survival.
Systemic inflammatory response predicts oncological outcomes in CRC patients, but only NLR has prognostic value in the dMMR group.
在许多实体器官癌症中，已经报道了各种炎症评分系统及其预后价值。本研究旨在探讨接受错配修复缺陷（dMMR）表型结直肠癌（CRC）择期手术的患者全身和局部炎症反应与肿瘤学结局之间的关系。
从一个前瞻性维护的数据库中确定接受 dMMR CRC 切除术的连续患者，并与具有良好错配修复系统肿瘤的患者队列进行比较。通过改良格拉斯哥预后评分（mGPS）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、淋巴细胞与单核细胞比值、C 反应蛋白/白蛋白比值、预后指数和预后营养指数评估全身炎症反应。局部炎症反应通过肿瘤浸润淋巴细胞、肿瘤浸润中性粒细胞、浆细胞或巨噬细胞在侵袭前沿的存在来定义。使用 Klintrup-Mäkinen（KM）评分评估炎症浸润。
单变量分析显示，术前 NLR≥5（风险比 [HR] 2.5；95%置信区间 [CI] 1.25-5.19；p=0.007）和 mGPS（HR 1.6；95%CI 1.1-2.6；p=0.03）预测总体生存率较差，但只有 NLR 与更高的复发相关（HR 3.6；95%CI 1.5-8.8；p=0.004）。通过 KM 评分（HR 0.31；95%CI 0.1-0.7；p=0.009）和肿瘤周围浸润中巨噬细胞的存在（HR 0.17；95%CI 0.07-0.3；p<0.001）来衡量的局部炎症反应增加与更好的结局相关。NLR 是总生存和无病生存的唯一独立预后因素。
全身炎症反应预测 CRC 患者的肿瘤学结局，但只有 NLR 在 dMMR 组中有预后价值。
