Systemic Inflammation and Outcome in 2295 Patients with Stage I–III Colorectal Cancer from Scotland and Norway: First Results from the ScotScan Colorectal Cancer Group
James H. Park, Anniken Jørlo Fuglestad, Anne Helene Køstner, Agata Oliwa, Janet Graham, Paul G. Horgan, Campbell S.D. Roxburgh, Christian Kersten, Donald C. McMillan
Abstract
BACKGROUND: Systemic inflammatory response (SIR) is an adverse prognostic marker in colorectal cancer (CRC) patients. The ScotScan Colorectal Cancer Group was established to examine how markers of the SIR differ between populations and may be utilised to guide prognosis. PATIENTS AND METHODS: Patients undergoing resection of stage I-III CRC from two prospective datasets in Scotland and Norway were included. The relationship between the modified Glasgow Prognostic Score (mGPS; combination of C-reactive protein and albumin) and overall survival (OS) was examined. The relationship between OS, adjuvant chemotherapy regime and mGPS was examined in patients with stage III colon cancer. RESULTS: A total of 2295 patients were included. Patients from Scotland were more inflamed despite controlling for associated characteristics using multivariate logistic regression or propensity score matching (OR 2.82, 95% CI 1.98-4.01, p < 0.001). mGPS had similar independent prognostic value in both cohorts (Scotland: HR 1.27, 95% CI 1.12-1.45; Norway: HR 1.23, 95% CI 1.01-1.49) and stratified survival independent of TNM group in the whole cohort. In patients with stage III colon cancer receiving adjuvant therapy, there appeared to be a survival benefit in systemically inflamed patients receiving oxaliplatin but not single-agent 5-fluorouracil or capecitabine. CONCLUSIONS: The SIR differs between populations from different countries; however prognostic value remains similar. The present study strongly supports the routine reporting of the mGPS in patients with CRC.