Cuk Vladica, Karamarkovic Aleksandar, Juloski Jovan, Arbutina Dragana, Radulovic Radosav, Milic Ljiljana, Kovacevic Bojan, De Luka Silvio, Grahovac Jelena
Zvezdara University Clinical Center, "Nikola Spasić" Surgical Clinic, Faculty of Medicine, University of Belgrade, Dimitrija Tucovica 161, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia.
Cancers (Basel). 2023 Mar 14;15(6):1761. doi: 10.3390/cancers15061761.
Colorectal cancer (CRC) is a significant public health problem. There is increasing evidence that the host's immune response and nutritional status play a role in the development and progression of cancer. The aim of our study was to examine the prognostic value of clinical markers/indexes of inflammation, nutritional and pathohistological status in relation to overall survival and disease free-survival in CRC. The total number of CRC patients included in the study was 111 and they underwent laboratory analyses within a week before surgery. Detailed pathohistological analysis and laboratory parameters were part of the standard hospital pre-operative procedure. Medical data were collected from archived hospital data. Data on the exact date of death were obtained by inspecting the death registers for the territory of the Republic of Serbia. All parameters were analyzed in relation to the overall survival and survival period without disease relapse. The follow-up median was 42 (24-48) months. The patients with the III, IV and V degrees of the Clavien-Dindo classification had 2.609 (HR: 2.609; 95% CI: 1.437-4.737; = 0.002) times higher risk of death. The modified Glasgow prognostic score (mGPS) 2 and higher lymph node ratio carried a 2.188 (HR: 2.188; 95% CI: 1.413-3.387; < 0.001) and 6.862 (HR: 6.862; 95% CI: 1.635-28.808; = 0.009) times higher risk of death in the postoperative period, respectively; the risk was 3.089 times higher (HR: 3.089; 95% CI: 1.447-6.593; = 0.004) in patients with verified tumor deposits. The patients with tumor deposits had 1.888 (HR: 1.888; 95% CI: 1024-3481; = 0.042) and 3.049 (HR: 3.049; 95% CI: 1.206-7.706; = 0.018) times higher risk of disease recurrence, respectively. The emphasized peritumoral lymphocyte response reduced the risk of recurrence by 61% (HR: 0.391; 95% CI: 0.196-0.780; = 0.005). Standard perioperative laboratory and pathohistological parameters, which do not present any additional cost for the health system, may provide information on the CRC patient outcome and lay the groundwork for a larger prospective examination.
结直肠癌（CRC）是一个重大的公共卫生问题。越来越多的证据表明，宿主的免疫反应和营养状况在癌症的发生和发展中起作用。我们研究的目的是探讨炎症、营养和病理组织学状态的临床标志物/指标对CRC患者总生存期和无病生存期的预后价值。本研究纳入的CRC患者总数为111例，他们在手术前一周内接受了实验室分析。详细的病理组织学分析和实验室参数是标准的医院术前程序的一部分。医疗数据从存档的医院数据中收集。通过查阅塞尔维亚共和国领土的死亡登记册获得确切的死亡日期数据。所有参数均与总生存期和无疾病复发生存期相关进行分析。随访中位数为42（24 - 48）个月。Clavien-Dindo分类为III、IV和V级的患者死亡风险高2.609倍（HR：2.609；95%CI：1.437 - 4.737；P = 0.002）。改良格拉斯哥预后评分（mGPS）为2及更高的淋巴结比率在术后分别有2.188倍（HR：2.188；95%CI：1.413 - 3.387；P < 0.001）和6.862倍（HR：6.862；95%CI：1.635 - 28.808；P = 0.009）的死亡风险；在有证实的肿瘤沉积物的患者中，风险高3.089倍（HR：3.089；95%CI：1.447 - 6.593；P = 0.004）。有肿瘤沉积物的患者疾病复发风险分别高1.888倍（HR：1.888；95%CI：1.024 - 3.481；P = 0.042）和3.049倍（HR：3.049；95%CI：1.206 - 7.706；P = 0.018）。突出的肿瘤周围淋巴细胞反应使复发风险降低了61%（HR：0.391；95%CI：0.196 - 0.780；P = 0.005）。标准的围手术期实验室和病理组织学参数对卫生系统而言不产生任何额外费用，可能提供有关CRC患者预后的信息，并为更大规模的前瞻性研究奠定基础。
