Abstract
Association of chronic inflammation, primary tumor sidedness, adjuvant therapy and survival of metastatic colorectal cancer (mCRC) remains unclear. Circulating inflammatory cell, fibrinogen (Fib), albumin (Alb), pre-albumin (pAlb), Alb/Fib (AFR) and Fib/pAlb (FPR) were detected, and clinical outcome was obtained to determine the predictive, prognostic and monitoring roles of them in discovery and validation cohort. We found that elevated FPR, low AFR and poor survival was observed in right-sided mCRC comparing to the left-sided disease, elevated FPR harbored the highest areas under curve to independently predict poor progression-free survival and overall survival in overall and left-sided mCRC case in two cohorts. No survival difference was examined between the two-sided patients in subgroups stratified by FPR. Radiochemoresistance was observed in high FPR case. However, the patient could benefit from bevacizumab plus radiochemotherapy. Low FPR patient showed the best survival with treatment of palliative resection plus radiochemotherapy. Moreover, circulating FPR was significantly increased ahead imaging confirmed progression and it reached up to the highest value within three months before death. Additionally, c-indexes of the prognostic nomograms including FPR were significantly higher than those without it. These findings indicated that FPR was an effective and independent factor to predict progression, prognosis and to precisely identify the patient to receive optimal therapeutic regimen.
Highlights
Colorectal cancer (CRC) is a kind of molecular heterogeneous disease that undergo a variety of clinical courses and possess diverse therapeutic responses [1,2,3]
We found that significant severe chronic inflammation and malnutrition represented by Fib to pre-albumin (pAlb) ratio (FPR) in right- and left-sided metastatic CRC (mCRC) contributed to radiochemoresistance, resulting in poor response and survival in both sides of mCRC patient
A total of 990 firstly diagnosed mCRC patients from November 2011 to May 2015 were prospectively identified in present study, discovery cohort including 430 mCRC patients who didn’t receive targeted therapy and validation cohort containing 77 mCRC cases undergoing bevacizumab plus radiochemotherapy were enrolled as eligible patients according to the inclusion and exclusion criteria
Summary
Colorectal cancer (CRC) is a kind of molecular heterogeneous disease that undergo a variety of clinical courses and possess diverse therapeutic responses [1,2,3]. A continued rightward of CRC was reported by several population-based epidemiological studies [10, 11], and the different origin of development as well as distinct anatomic structure were observed in colon and rectal cancer [12]. The clinical utility of this distinction remains unclear in adjuvant therapy response, recurrence and clinical outcome within the right- and light-sided localized CRC. Cetuximab plus fluorouracil based chemotherapy was commonly recommended and accepted for treatment of KRAS wild-type metastatic CRC (mCRC) patient, whereas the left-sided individual was reported more responsive to the therapeutic regimen[16, 17], and the survival of leftmCRC individual was extremely superior to the right patients[15, 18]. The leading cause of this distinct response remains unknown, and other unmeasured confounding factors that would interfere with the regimen efficacy should be considered within the two-sided mCRC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
