Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12410-12420
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12410
Comparison of selected inflammation-based prognostic markers in relapsed or refractory metastatic colorectal cancer patients
Anna Song, Wankyu Eo, Sookyung Lee
Anna Song, Sookyung Lee, Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, Seoul 134-727, South Korea
Wankyu Eo, Department of Medical Oncology, College of Medicine, Kyung Hee University, Seoul 134-727, South Korea
Author contributions: Song A analyzed the data and wrote the draft of manuscript; Eo W suggested the research hypothesis and advised on statistical analyses; Lee S performed the research setup and critically revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Kyung Hee University Hospital at Gangdong (KHNMC-OH-IRB 2013-010).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment before initiation of treatment.
Conflict-of-interest statement: We have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sookyung Lee, KMD, PhD, Associate Professor, Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, South Korea. sookyung@khu.ac.kr
Telephone: +82-2-4406229 Fax: +82-2-4407267
Received: March 21, 2015
Peer-review started: March 23, 2015
First decision: June 19, 2015
Revised: June 30, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: November 21, 2015
Abstract

AIM: To investigate the impact of systemic inflammation-based prognostic markers on overall survival in relapsed/refractory metastatic colorectal cancer (mCRC) patients.

METHODS: To investigate prognostic markers in mCRC patients, this study was performed with patients who have experienced relapsed/refractory mCRC with standard chemotherapy or were inapplicable to conventional treatment modality because of poor performance status, age, or comorbidity. We reviewed the medical records of 177 mCRC patients managed with Korean Medicine (KM) treatment modality using an anticancer agent of Rhus verniciflua Stokes extract from June 2006 to April 2013. The clinicopathologic characteristics, laboratory test, the systemic inflammation markers including the modified Glasgow prognostic score (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), and prognostic nutritional index (PNI) were analyzed. The overall survival of patients was calculated with the Kaplan-Meier method and the statistical significance was compared using with the log-rank test. To compare the impact of systemic inflammation based markers, the hazard ratio (HR) of mGPS, NLR, PLR, LMR, and PNI for overall survival were evaluated with the Cox proportional hazards regression.

RESULTS: The majority of mCRC patients had relapsed/refractory to standard chemotherapy; 128 patients (72.3%) had undergone more than second line chemotherapy, and the median time from diagnosis of mCRC to initiation of KM was 9.4 mo. The median overall survival of enrolled patients was 8.3 mo. On univariate analyses, the inflammation markers of higher mGPS (P < 0.001), NLR ≥ 5 (P < 0.001), PLR > 300 (P = 0.004), LMR ≤ 3.4 (P < 0.001), and PNI ≤ 45.3 (P = 0.001) were significantly associated with decreased survival time. On stepwise multivariate proportional hazards model, mGPS at 2 vs 0 (HR = 3.212, 95%CI: 1.437-7.716, P = 0.004), and LMR ≤ 3.4 (HR = 1.658, 95%CI: 1.092-2.518, P = 0.018) as independent predictors associated with poor overall survival along with carbohydrate antigen 19-9 (HR = 1.482, 95%CI: 1.007-2.182, P = 0.046), AST ≥ 40 (HR = 2.377, 95%CI: 1.359-4.155, P = 0.002), and the treatment duration for KM less than 2.9 mo (HR = 1.718, 95%CI: 1.160-2.543, P = 0.007).

CONCLUSION: These results indicate that the inflammatory markers, mGPS and LMR are independent prognostic factors for predicting overall survival in relapsed/refractory mCRC patients.

Keywords: Colorectal neoplasm, Inflammation, Modified Glasgow prognostic score, Lymphocyte monocyte ratio, Prognosis

Core tip: This is a retrospective study to compare the systemic inflammation based prognostic markers in relapsed or refractory metastatic colorectal cancer (mCRC) patients. We reviewed the medical records of 177 mCRC patients and analyzed the impact of systemic inflammation markers including modified Glasgow prognostic score (mGPS), neutrophil lymphocyte ratio, platelet lymphocyte ratio, lymphocyte monocyte ratio (LMR), and prognostic nutritional index on survival time. The mGPS and LMR were the best inflammatory markers for predicting overall survival time in relapsed or refractory mCRC patients.