Clinical Implications of Systemic Inflammatory Response Markers as Independent Prognostic Factors in Colorectal Cancer Patients
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PurposeCancer-related inflammation affects many aspects of malignancy. We confirm theeffects of early postoperative systemic inflammation on cancer prognosis. Materials and MethodsSix hundred consecutive patients underwent surgery for colorectal cancer from 2006to 2009. Measurements of white blood cells, neutrophils, lymphocytes, monocytes,and platelet counts were performed preoperatively, daily until the fourth postoperativeday, and subsequently every two days. Patients were divided into three groups basedon the days spent on the leukocyte count to drop below 10,000/mm3 after surgery. ResultsPreoperative white blood cell (WBC) counts correlated with stage of disease. In univariate survival analyses, tumor, node, metastasis (TNM) stage, and monocytecount were associated with cancer-free survival. In addition, cancer-free survivaloutcomes were worse in patients who required more than four days for the normalizationof WBC count. A TNM stage greater than II and the neutrophil lymphocyte ratiowere associated with the duration of overall survival. In a multivariate analysis ofthese significant variables, TNM stage, an interval longer than four days for normalizationof WBC counts and monocyte count independently associated with cancerfreesurvival. ConclusionPostoperative early inflammatory phase and preoperative monocyte count correlatewith poor colon cancer prognosis. We can conclude that preoperative and postoperativeinflammatory response and period unfavorably affect the metastatic microenvironment
Abstract
PurposeCancer-related inflammation affects many aspects of malignancy. We confirm theeffects of early postoperative systemic inflammation on cancer prognosis. Materials and MethodsSix hundred consecutive patients underwent surgery for colorectal cancer from 2006to 2009. Measurements of white blood cells, neutrophils, lymphocytes, monocytes,and platelet counts were performed preoperatively, daily until the fourth postoperativeday, and subsequently every two days. Patients were divided into three groups basedon the days spent on the leukocyte count to drop below 10,000/mm3 after surgery. ResultsPreoperative white blood cell (WBC) counts correlated with stage of disease. In univariate survival analyses, tumor, node, metastasis (TNM) stage, and monocytecount were associated with cancer-free survival. In addition, cancer-free survivaloutcomes were worse in patients who required more than four days for the normalizationof WBC count. A TNM stage greater than II and the neutrophil lymphocyte ratiowere associated with the duration of overall survival. In a multivariate analysis ofthese significant variables, TNM stage, an interval longer than four days for normalizationof WBC counts and monocyte count independently associated with cancerfreesurvival. ConclusionPostoperative early inflammatory phase and preoperative monocyte count correlatewith poor colon cancer prognosis. We can conclude that preoperative and postoperativeinflammatory response and period unfavorably affect the metastatic microenvironment
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