Colorectal Cancer, Systemic Inflammation, and Outcome: Staging the Tumor and Staging the Host

OBJECTIVE:This study aims to examine the clinical utility of the combination of TNM stage and modified Glasgow Prognostic Score (mGPS) in patients undergoing potentially curative resection of colorectal cancer (CRC). BACKGROUND:Of measures of the systemic inflammatory response, the mGPS has been most extensively validated in patients with cancer. METHODS:Data from 1000 consecutive patients undergoing potentially curative CRC resection from a single institution (January 1997–May 2013) were included. The relationship between mGPS [0–C-reactive protein (CRP) ≤ 10 mg/L, 1—CRP > 10 mg/L and albumin ≥35 g/L, 2—CRP > 10 mg/L and albumin < 35 g/L], TNM stage, and cancer-specific survival (CSS) and overall survival (OS) was examined using Kaplan-Meier log-rank survival analysis and multivariate Cox regression analysis. RESULTS:An mGPS of 0, 1, and 2 was observed in 63%, 21%, and 16% of patients, respectively. Median follow-up was 56 months (interquartile range28–107 months). TNM and mGPS were independently associated with CSS and OS (all P < 0.001). In all patients, TNM and mGPS stratified 5-year CSS and OS from 97% and 87% (stage I, mGPS = 0) to 32% and 26% (stage III, mGPS = 2), respectively. In patients undergoing elective resection of colon cancer (n = 575), 5-year CSS and OS ranged from 100% and 87% (stage I, mGPS = 0) to 37% and 30% (stage III, mGPS = 2), respectively. CONCLUSIONS:This study shows how the combination of TNM and mGPS effectively stratifies outcome in patients undergoing potentially curative resection of CRC. These data support routine staging of both the tumor and the host in patients with CRC.