Natalie Turner1, Ben Tran2, Phillip V Tran3, Mathuranthakan Sinnathamby4, Hui-Li Wong5, Ian Jones6, Matthew Croxford7, Jayesh Desai1, Jeanne Tie8, Kathryn Maree Field4, Suzanne Kosmider9, Susie Bae10, Peter Gibbs11. 1. Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia; University of Melbourne, Melbourne, Australia. 2. Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia; University of Melbourne, Melbourne, Australia; Department of Oncology, Western Health, Footscray, Australia. Electronic address: ben.tran@mh.org.au. 3. Department of Radiology, Western Health, Footscray, Australia. 4. Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia. 5. Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia; University of Melbourne, Melbourne, Australia. 6. Department of Colorectal Surgery, The Royal Melbourne Hospital, Parkville, Australia. 7. Department of Colorectal Surgery, Western Health, Footscray, Australia. 8. Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia; University of Melbourne, Melbourne, Australia; Department of Oncology, Western Health, Footscray, Australia. 9. Department of Oncology, Western Health, Footscray, Australia. 10. BioGrid Australia, Melbourne, Australia. 11. Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Australia; University of Melbourne, Melbourne, Australia; Department of Oncology, Western Health, Footscray, Australia; BioGrid Australia, Melbourne, Australia.
Abstract
BACKGROUND: The true survival benefit of noncurative primary tumor resection in patients with de novo metastatic colorectal cancer (mCRC) remains uncertain. The present study examined the effect of primary tumor resection on systemic inflammation and survival in patients with mCRC. MATERIALS AND METHODS: Consecutive patients with de novo mCRC who had undergone primary tumor resection were identified from a prospective database. Patients were excluded if they had undergone resection of metastases, had undergone delayed primary resection, or if blood samples were unavailable. The neutrophil/lymphocyte ratio (NLR) was used as a biomarker of systemic inflammation. Overall survival (OS) was compared between patient groups according to the pre- and postprimary resection NLR. The associations between the reversal of an elevated NLR and primary tumor bulk or performance status were explored. RESULTS: A total of 145 eligible patients were identified from the database, with a median age of 70 years. The baseline NLR was elevated (> 5) in 65 patients, 36 (55%) of whom had a low NLR after surgery. The reversal of an elevated NLR was associated with significantly improved OS (hazard ratio, 0.53; P = .017). A similar benefit was seen after excluding patients undergoing emergency primary resection. NLR reversal was more frequent in patients with larger primary tumors or good performance status. CONCLUSION: The present study is the first to demonstrate a relationship between the reversal of a systemic inflammatory response and the improved survival after primary resection in those with mCRC. A greater effect was seen in patients with large primary tumors. If validated, these observations could guide clinical decision-making in patients with mCRC at presentation.
BACKGROUND: The true survival benefit of noncurative primary tumor resection in patients with de novo metastatic colorectal cancer (mCRC) remains uncertain. The present study examined the effect of primary tumor resection on systemic inflammation and survival in patients with mCRC. MATERIALS AND METHODS: Consecutive patients with de novo mCRC who had undergone primary tumor resection were identified from a prospective database. Patients were excluded if they had undergone resection of metastases, had undergone delayed primary resection, or if blood samples were unavailable. The neutrophil/lymphocyte ratio (NLR) was used as a biomarker of systemic inflammation. Overall survival (OS) was compared between patient groups according to the pre- and postprimary resection NLR. The associations between the reversal of an elevated NLR and primary tumor bulk or performance status were explored. RESULTS: A total of 145 eligible patients were identified from the database, with a median age of 70 years. The baseline NLR was elevated (> 5) in 65 patients, 36 (55%) of whom had a low NLR after surgery. The reversal of an elevated NLR was associated with significantly improved OS (hazard ratio, 0.53; P = .017). A similar benefit was seen after excluding patients undergoing emergency primary resection. NLR reversal was more frequent in patients with larger primary tumors or good performance status. CONCLUSION: The present study is the first to demonstrate a relationship between the reversal of a systemic inflammatory response and the improved survival after primary resection in those with mCRC. A greater effect was seen in patients with large primary tumors. If validated, these observations could guide clinical decision-making in patients with mCRC at presentation.
Authors: Georgia M Carroll; Grace L Burns; Joel A Petit; Marjorie M Walker; Andrea Mathe; Stephen R Smith; Simon Keely; Peter G Pockney Journal: Surg Open Sci Date: 2020-01-23
Authors: Narimantas E Samalavicius; Audrius Dulskas; Edita Baltruskeviciene; Giedre Smailyte; Marija Skuciene; Rasa Mikelenaite; Rasa Venslovaite; Eduardas Aleknavicius; Almantas Samalavicius; Raimundas Lunevicius Journal: Wideochir Inne Tech Maloinwazyjne Date: 2016-12-31 Impact factor: 1.195
Authors: Rosemary Millen; Shona Hendry; Vignesh Narasimhan; Rebecca Abbott; Matthew Croxford; Peter Gibbs; Jeanne Tie; Hui-Li Wong; Ian Jones; Suzanne Kosmider; David Byrne; John Zalcberg; Stephen Fox; Jayesh Desai; Kumar Visvanathan; Robert G Ramsay; Ben Tran Journal: Clin Transl Immunology Date: 2020-07-17