title: Serum inflammatory markers and colorectal cancer risk and survival.
abstract: BACKGROUND
  Inflammation has been linked with development of some cancers. We investigated systemic inflammation in relation to colorectal cancer incidence and subsequent survival using common serum inflammatory markersDesign:A cohort of men and women aged 20 years and older in greater Stockholm area with serum C-reactive protein (CRP) and albumin measured between 1986 and 1999 were included (n=325 599). A subset of these had baseline measurements of haptoglobin and leukocytes. Multivariable Cox regression was performed to assess risk of colorectal cancer by levels of inflammatory markers, adjusting for potential confounders. Analyses were stratified by circulating glucose, total cholesterol and triglycerides. Overall and CRC-specific death following diagnosis were assessed as secondary outcomes.
  
  
  RESULTS
  A total of 4764 individuals were diagnosed with colorectal cancer. A positive association between haptoglobin and colorectal cancer incidence was found (hazard ratio (HR): 1.17; 95% CI: 1.06-1.28). A positive association was also observed with leukocytes (HR: 1.21; 95% CI: 1.03-1.42). No evidence of association was noted between CRP and colorectal cancer risk. Higher risks of all-cause death were seen with haptoglobin and leukocytes levels. Higher haptoglobin levels were linked with an increased risk of colorectal cancer death (HR: 1.19; 95% CI: 1.01-1.41).
  
  
  CONCLUSIONS
  Prediagnostic systemic inflammation may impact colorectal cancer incidence and survival; therefore, prompting investigations linking inflammatory pathways preceding colorectal cancer with disease severity and progression.
authors.affiliation: Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Ghuman
authors.affiliation: Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.affiliation: Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.|Regional Cancer Centre, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.|Regional Cancer Centre, Uppsala, Sweden.|Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Malmström
authors.affiliation: Regional Cancer Centre, Uppsala, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.|Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.affiliation: Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Walldius
authors.affiliation: Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Jungner
authors.affiliation: Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.|Medical Research Council Unit for Lifelong Health and Ageing at University College London, London, UK.
authors.forename: Wahyu
authors.initials: W
authors.lastname: Wulaningsih
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006242:Haptoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D006242:Haptoglobins; D012709:Serum Albumin; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol