Abstract
IntroductionInflammatory biomarkers are useful prognostic tools in cancer patients. However, the prognostic and predictive value of inflammatory biomarkers beyond the 1st-line setting in metastatic colorectal cancer (mCRC) is unclear.ResultsIn multivariate analysis 1 standard deviation increase in neutrophil-lymphocyte-ratio (NLR) was associated with an 8.5% absolute lower objective-response-rate (ORR) in 1st-line (p<0.0001), 3% lower ORR in 2nd-line (p< 0.0001), and 3% lower ORR in 3rd-line (p=0.24), respectively. Regarding progression free survival (PFS), an increase in the NLR was significantly associated with rising hazard-ratios (HR) over all treatment lines (HR=1.30, p= 0.021 1st-line); (HR=1.37, p<0.0001 2nd-line); (HR=1.44, p=0.042 3rd-line). The platelet-lymphocyte-ratio (PLR) was associated with 6-month PFS over all three treatment lines. Higher C-reactive-protein (CRP) predicted for worse PFS in the first two chemotherapy lines and in best supportive care (BSC). (HR=1.49 (p<0.0001 1st-line); HR=1.25 (p=0.007 2nd-line); HR=1.09 (95%CI 0.81–1.48, p=0.552 3rd-line and HR=1.43 (p= 0.002 in BSC)).MethodsTwo-hundred-fifty-eight patients with mCRC undergoing palliative chemo(immuno-)therapy were retrospectively included. Primary endpoints were 6-month PFS and ORR during 1st-line, 2nd-line, and 3rd-line treatment, and 6-month overall survival during BSC.ConclusionThis study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in mCRC patients.
Highlights
Inflammatory biomarkers are useful prognostic tools in cancer patients
This study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in metastatic colorectal cancer (mCRC) patients
Since inflammation was shown to play a crucial role in the pathogenesis and promotion of cancer progression, inflammatory biomarkers have gained more attraction as www.impactjournals.com/oncotarget potential predictive and prognostic parameters in recent years. [3, 4] A variety of routinely available blood based markers of inflammation such as hypalbuminaemia, C-reactive protein level (CRP), blood cell counts and its ratios like the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), or the platelet-tolymphocyte ratio (PLR) have been investigated in different cancer entities as prognostic tools. [5,6,7,8,9,10] only few data exist regarding the prognosis of survival outcomes and prediction of therapy response in metastatic colorectal cancer beyond the first-line treatment setting
Summary
Inflammatory biomarkers are useful prognostic tools in cancer patients. The prognostic and predictive value of inflammatory biomarkers beyond the 1st-line setting in metastatic colorectal cancer (mCRC) is unclear. Up to date only limited data exists to predict therapy response and survival outcome in CRC patients. [5,6,7,8,9,10] only few data exist regarding the prognosis of survival outcomes and prediction of therapy response in metastatic colorectal cancer beyond the first-line treatment setting. The aim of this study was to examine the value of blood-based inflammatory biomarkers as prognostic and predictive markers for therapy response and disease outcome during the first three chemotherapy lines, and after start of best-supportive-care (BSC) only treatment concept in mCRC patients Since inflammation was shown to play a crucial role in the pathogenesis and promotion of cancer progression, inflammatory biomarkers have gained more attraction as www.impactjournals.com/oncotarget potential predictive and prognostic parameters in recent years. [3, 4] A variety of routinely available blood based markers of inflammation such as hypalbuminaemia, C-reactive protein level (CRP), blood cell counts and its ratios like the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), or the platelet-tolymphocyte ratio (PLR) have been investigated in different cancer entities as prognostic tools. [5,6,7,8,9,10] only few data exist regarding the prognosis of survival outcomes and prediction of therapy response in metastatic colorectal cancer beyond the first-line treatment setting.
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