title: Scoring of prognostic parameters in patients with unresectable advanced or recurrent colorectal cancer undergoing chemotherapy.
abstract: BACKGROUND
  Suitable chemotherapy is needed to prolong the survival of patients with unresectable advanced or recurrent colorectal cancer. We scored the periodical changes of several prognostic markers during chemotherapy in patients with this type of cancer to discern the effectiveness of chemotherapy.
  
  
  METHODS
  Twenty consecutive patients with unresectable advanced or recurrent colorectal cancer were enrolled. All patients underwent combination chemotherapy with oxaliplatin or irinotecan plus 5-fluorouracil/leucovorin. Neutrophil/lymphocyte ratio (NLR), serum C-reactive protein (CRP), serum carcinoembryonic antigen (CEA) and serum albumin (ALB) were compared between the two periods (before chemotherapy and 3 months after it was started) in each patient. The scoring system was as follows: points are added when a patient shows a decrease of NLR, CRP and CEA and an increase of ALB at 3 months after the start of chemotherapy with a possible final score of +4. On the other hand, points are reduced if a patient shows an elevation of NLR, CRP and CEA and a decrease of ALB at 3 months after the start of chemotherapy with a possible final score of -4.
  
  
  RESULTS
  At 3 months after the start of first line chemotherapy, 13 patients showed positive scores but 7 patients showed zero or minus scores. According to our scoring system, we found the mean survival time (MST) of the 13 patients with plus scores was 34 months and this was significantly better than that of the 7 patients who showed zero or minus scores (P = 0.0008).
  
  
  CONCLUSIONS
  Our new scoring system is useful but when we find that first line chemotherapy is ineffective, we need to change it to second line chemotherapy as soon as possible. That may be the best treatment for patients with unresectable advanced or recurrent colorectal cancer.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ikeguchi
authors.forename: Ryugo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Manabu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maeta
authors.forename: Keigo
authors.initials: K
authors.lastname: Ashida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
keywords: chemotherapy; colorectal cancer; immunity; inflammation; nutrition