title: Role of systemic inflammation scores in pulmonary metastasectomy for colorectal cancer.
abstract: BACKGROUND
  Patients with pulmonary metastases from colorectal cancer can benefit from surgical removal. However, the biological determinants of postsurgical outcome are not completely elucidated. We evaluated the role of host systemic inflammation status in this setting.
  
  
  METHODS
  The modified Glasgow prognostic score (based on serum C-reactive protein and albumin levels) and the neutrophil-to-lymphocyte (NTL) ratio were obtained from 44 patients who received curative-intent metastasectomy, and were used as indicators of systemic inflammation status. We tested the impact of both of these parameters on overall survival (OS) and progression-free survival (PFS), as well as their correlation with other well-known prognosticators.
  
  
  RESULTS
  Five-year PFS and OS rates were 18% and 49%, respectively. At univariate analysis, multiple metastases, disease-free interval <36 months, and a Glasgow score of 2 (P = 0.031) were significantly associated to a worse PFS rate. A NTL ratio >3 predicted disease progression in the short-term (P = 0.036), but the effect on late events was weaker (P = 0.079). Factors associated with worse OS were multiple metastasis (P = 0.002), elevated carcinoembryonic antigen (P = 0.009), a Glasgow score of 2 (P = 0.029), and a faster metastasis growth (P = 0.008). At Cox regression analysis, neither a Glasgow score of 2, nor elevated NTL ratio showed an independent effect on survival rates.
  
  
  CONCLUSIONS
  Systemic inflammation scores did not perform well as independent survival prognosticators in patients undergoing curative-intent pulmonary metastasectomy. Further investigation is warranted to evaluate whether these measurements could still be useful when restricting the analysis to specific patient subcategories or to diverse postoperative phases.
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Rome, Italy.
authors.forename: Tommaso Claudio
authors.initials: TC
authors.lastname: Mineo
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tacconi
keywords: Albumin; C-reactive protein; colorectal cancer; neutrophil-to-lymphocyte ratio; pulmonary metastasectomy