Differences in the prognostic impact of post-operative systemic inflammation and infection in colorectal cancer patients: Using white blood cell counts and procalcitonin levels

Abstract

BackgroundSystemic inflammatory responses cause poor prognosis in cancer patients. However, post-operative systemic inflammatory response may occur owing to post-operative infection as well as cancer-related inflammation. This study aimed to identify the prognostic impact of cancer-related inflammation and infection for colorectal cancer. MethodsPatients who underwent curative surgery for colorectal cancer between January 2011 and March 2015 were enrolled. Procalcitonin (PCT) levels were measured on the fourth post-operative day; white blood cell (WBC) counts were measured daily until the fourth post-operative day. Patients were divided into groups according to the number of post-operative days required for the leukocyte count to decrease to <10,000/mm3 and PCT levels (0.5 ng/ml) as follows: group I, 0–3 days; group II, ≥4 days and high PCT; group III, ≥4 days and normal PCT. ResultsTotally, 248 patients were identified. A prolonged WBC normalization period was associated with poor disease-free survival (DFS). TNM stage III and IV and group III (hazard ratio [HR] 2.480, 95% confidence interval [CI] 1.137–5.410) were independently associated with poor DFS. In contrast, DFS was not significantly affected in group II. High PCT levels were significantly associated with post-operative infectious complications (odds ratio 10.579, 95% CI 4.182–26.764). Although infectious complication had no prognostic significance for DFS, it was an independently poor prognostic factor for overall survival (HR 3.728; 95% CI 1.291–10.766). ConclusionsThe increased post-operative systemic inflammatory response was associated with poor prognosis of colorectal cancer. Otherwise, post-operative infection affected overall mortality but was not associated with disease progression.