title: The relationship between the local and systemic inflammatory responses and survival in patients undergoing curative surgery for colon and rectal cancers.
abstract: BACKGROUND
  Both local (Klintrup criteria) and systemic (Glasgow Prognostic Score, mGPS) inflammatory responses have been reported to be independent predictors of cancer-specific survival in colorectal cancer. However, high-grade local inflammatory response appears more common in rectal and high mGPS more common in colonic tumors. Whether relationships with survival are similar in colon and rectal tumors is unclear. The present study assesses the prognostic value of local and systemic inflammation in colon and rectal cancers and defines 3-year survival according to inflammation-based criteria for stage II/III disease.
  
  
  METHODS
  Two hundred forty colon and 140 rectal cancer patients underwent potentially curative surgery between 1997 and 2007. C-reactive protein and albumin (mGPS) were measured preoperatively. Routine pathology specimens were scored according to Klintrup criteria for peritumoral infiltrate.
  
  
  RESULTS
  Patients with colon cancers were older (P < 0.05) and had higher T stage (P < 0.001) and mGPS (P < or = 0.001) compared with rectal cancers. The proportions of patients with a high-grade tumor inflammatory cell infiltrate were similar in colon and rectal cancers. mGPS and Klintrup criteria were independent predictors of cancer survival. The mGPS hazard ratios were 1.56 and 1.76 for the mGPS, and the Klintrup hazard ratios were 2.12 and 5.74 for colon and rectum, respectively. For stages II and III colorectal cancer, 3-year survival was 91% and 73%, respectively. Three-year survival varied between 100% and 68% depending on Klintrup score/ mGPS in stage II disease and between 97% and 60% in stage III disease.
  
  
  CONCLUSIONS
  Local and systemic inflammatory responses are important independent predictors of survival in colon and rectal cancers. These scores combined with tumor-node-metastases stage improve the prediction of survival in these patients.
authors.affiliation: University Department of Surgery, Faculty of Medicine, University of Glasgow Royal Infirmary, Glasgow, UK. campbellroxburgh@doctors.net.uk
authors.forename: Campbell S D
authors.initials: CS
authors.lastname: Roxburgh
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Salmond
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Karin A
authors.initials: KA
authors.lastname: Oien
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003106:Colon / Q000473:pathology; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D012007:Rectum / Q000473:pathology; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein