Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer

Abstract

BackgroundLocally advanced colorectal cancer (CRC) may vary in its clinical and pathological appearance. It is now accepted that progression of disease in patients with locally advanced CRC is determined not only by local tumor characteristics but also by the immune system and inflammatory response in the body.MethodsWe investigated patients with confirmed CRC who were treated in the surgical clinic at the University Hospital Alexandrovska over a 10-year period and retrospectively evaluated the histological features of the preoperative biopsies and operative specimens removed during radical multivisceral resections. We also collected prospective data for serum C-reactive protein levels and Jass-Klintrup score, Petersen Index score, and Glasgow Prognostic Score in patients with locally advanced CRC.ResultsOf 1,105 patients with CRC, 327 (29.6%) were diagnosed with locally advanced disease. In total, 108 combined multivisceral resections (79 for primary tumors and 29 for recurrent tumors) were performed. Overall survival was 34 months for pR0 cases and 12 months for pR1 cases (P<0.05). Our data confirmed that C-reactive protein is a prognostic marker of overall survival. Data for 48 patients with histologically confirmed locally advanced tumors showed significantly increased survival with a higher Jass-Klintrup score (P=0.037). In patients with node-negative disease, 5-year survival was 49%. However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702). Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031).ConclusionIn order to maintain a reasonable balance between an aggressive approach and so-called meaningless “surgical exorbitance”, we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

Clinical and Prognostic Significance of Pathological and Inflammatory Markers in Mucinous Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy and Curative Surgery

“…An inflammatory microenvironment promotes the development of tumors by promoting angiogenesis and metastasis, subverting adaptive immune responses, and altering responses to hormones and chemotherapeutic agents [ 14 , 15 ]. Recently, the markers of systematic inflammatory response, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), have been reported to be associated with pathological complete response [ 16 – 19 ] and prognosis of colorectal cancer [ 20 – 24 ]. However, all of these reports included all histopathological types of colorectal cancer, and there have been no reports on the predictive role of systematic inflammatory response in mucinous rectal cancer.…”

Microenvironmental markers are correlated with lymph node metastasis in invasive submucosal colorectal cancer

“…In the present study, we examined perineural invasion (PNI), 19 tumour border configuration 20 and peritumoral inflammation (using a ‘Jass‐Klintrup score with a modification’: 0, 1, mild; 2, moderate; 3, strong). 21 These characteristics were reported to be helpful in the prediction of LNM. 19 , 20 , 21 Notably, PNI was not observed in the present study.…”

“… 21 These characteristics were reported to be helpful in the prediction of LNM. 19 , 20 , 21 Notably, PNI was not observed in the present study. Tumour border configuration was classified into three classes, including expansive, intermediate and invasive types, in accordance with a previous study, with modification.…”

Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Inflammatory Markers in Colorectal Cancer Surgery

“…[ 14 15 ] CRP is not a specific marker of infection, but regardless of all its limitations, CRP is the most commonly used inflammatory marker for perioperative monitoring. [ 16 17 ]…”