Academic Unit of Surgery-Glasgow Royal Infirmary, Glasgow, UK.
Br J Cancer. 2021 May;124(11):1828-1835. doi: 10.1038/s41416-021-01308-x. Epub 2021 Mar 24.
The pre-operative systemic inflammatory response (SIR) measured using an acute-phase-protein-based score (modified Glasgow Prognostic Score (mGPS)) or the differential white cell count (neutrophil-lymphocyte ratio (NLR)) demonstrates prognostic significance following curative resection of colon cancer. We investigate the complementary use of both measures to better stratify outcomes.
The effect on survival of mGPS and NLR was examined using uni/multivariate analysis (UVA/MVA) in patients undergoing curative surgery for colon cancer. The synergistic effect of these scores in predicting OS/CSS was examined using a Systemic Inflammatory Grade (SIG).
One thousand seven hundred and eight patients with TNM-I-III colon cancer were included. On MVA both mGPS and NLR were significant for OS (HR 1.16/1.21, respectively). Three-year survival stratified by mGPS was 83-58%(TNM-I-III), 87-65%(TNM-II) and 75-49%(TNM-III), and by NLR was 84-62%(TNM-I-III), 88-69%(TNM-II) and 77-49%(TNM-III). When mGPS and NLR were combined to form an overall SIG 0/1/2/3/4, this stratified 3-year OS 88%/84%/76%/65%/60% and CSS 93%/90%/82%/73%/70%, respectively (both p < 0.001). SIG stratified OS 93-68%/82-48% and CSS 97-80%/86-58% in TNM Stage II/III disease, respectively (all p < 0.001).
The present study shows that the pre-operative SIR in patients undergoing curative surgery for colon cancer is best measured using a SIG utilising mGPS and NLR.
使用基于急性期蛋白的评分（改良格拉斯哥预后评分（mGPS））或白细胞分类计数（中性粒细胞-淋巴细胞比值（NLR））测量的术前全身炎症反应（SIR）在结直肠癌根治性切除术后显示出预后意义。我们研究了这两种方法的互补使用，以更好地分层结果。
使用单变量/多变量分析（UVA/MVA）检查 mGPS 和 NLR 对接受结直肠癌根治性手术的患者的生存影响。使用系统炎症分级（SIG）检查这些评分预测 OS/CSS 的协同作用。
共纳入 1708 例 TNM-I-III 期结肠癌患者。在 MVA 中，mGPS 和 NLR 对 OS 均有显著影响（HR 分别为 1.16/1.21）。根据 mGPS 分层的 3 年生存率为 83-58%（TNM-I-III）、87-65%（TNM-II）和 75-49%（TNM-III），根据 NLR 分层的 3 年生存率为 84-62%（TNM-I-III）、88-69%（TNM-II）和 77-49%（TNM-III）。当 mGPS 和 NLR 结合形成整体 SIG 0/1/2/3/4 时，分别分层 3 年 OS 为 88%/84%/76%/65%/60%和 CSS 为 93%/90%/82%/73%/70%（均 p<0.001）。SIG 分别分层 OS 为 93-68%/82-48%和 CSS 为 97-80%/86-58%，在 TNM 分期 II/III 期疾病中（均 p<0.001）。
本研究表明，在接受结直肠癌根治性手术的患者中，术前 SIR 最好使用 mGPS 和 NLR 联合使用的 SIG 来测量。
