Inflammation-Based Scores: A New Method for Patient-Targeted Strategies and Improved Perioperative Outcome in Cancer Patients

Abstract

Systemic inflammatory response (SIR) has actually been shown as an important prognostic factor associated with lower postoperative survival in several types of cancer. Thus, the challenge for physicians is to find specific, low-cost, and highlyreliable inflammatory markers, clearly correlated with prognosis and able to preoperatively stratify patient's risk. Inflammation is a promising target to improve perioperative outcome, and data show that anti-inflammation techniques have a great potential in the perioperative period of cancer surgery. Inflammation scores could be useful to stratify patients with a potential better response to anti-inflammation strategies. Furthermore, inflammation scores could prevent failure of clinical trials by a better definition of patients to be included in such trials; inflammation scoring could clarify the real role of different drugs and techniques on outcome after cancer surgery, defining if different therapies are required for different patients. The role of this review is to focus on the currently available scores, in order to clarify their rationale and to analyze the actual evidence and limits, providing physicians with an updated overview of the possible inflammation-based prognostic scores for cancer patients undergoing surgery.

Preoperative albumin/globulin ratio is a potential prognosis predicting biomarker in patients with resectable gastric cancer

“…acute-phase reaction proteins, which are calculated as part of the serum globulin, and suppress the synthesis of albumin (6). In addition, albumin plays a significant role in the distribution and pharmacological activities of anticancer drugs (7).…”

The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection

“…36 Accordingly, specific scores have been established on the basis of inflammatory markers that have been validated as prognosticators of therapy response and outcome in patients with solid malignancies. 6,7,9,17,18,20,[37][38][39][40][41] However, some of these prognostic scores require extended analysis of differential blood cell count, which is not routinely measured in patients with primary PDAC undergoing resection. [6][7][8]10,18,40,41 The PI involves CRP and WBC as prognostic biomarkers.…”

“…15,16 The link between systemic inflammation and tumour behaviour implies the identification of clinically available surrogate markers to determine the extent of the disease. [17][18][19] The Prognostic Index (PI) was first described in a cohort of patients with advanced non-small-cell lung cancer, where it showed a significant value for survival prognosis. The PI can easily be calculated from CRP serum concentration and white blood count (WBC) derived preoperatively.…”

Comparative Study of CRP and Serum Albumin as Stress Response Markers in Laparoscopic Versus Open Cholecystectomy

“…The use of CRP levels on or after 2 nd post-operative day has also been advocated as predictor for (Infectious) complications. 26 Kinetics of CRP is rather slow, and plasma peaks are only reached after 2 nd and 3 rd post-operative day. 27 This leads to predictive delay in taking decisive actions in time.…”