Peritumoral CD3+inflammation and neutrophil to lymphocyte ratio predict overall survival in patients affected by colorectal liver metastases treated with surgery

Abstract

Background: Systemic and local inflammation plays an important role in many cancers and colorectal liver metastases (CRLM). While the role of local immune response mediated by CD3+ tumour infiltrating lymphocyte is well established new evidence on systemic inflammation and cancer such as neutrophil-lymphocyte ratio (NLR) are emerging. The aim of the study is to associate systemic and local inflammation to predict overall survival (OS) and recurrence free survival (RFS) in CRLM. Methods: 128 patients (2008-2013) affected by CRLM treated with chemotherapy and surgery were analysed. Different cut-off were calculated with ROC curves for each biomarkers and their relative outcome (OS or RFS). Associating the two biomarkers three risk groups were determined: low risk group (two protective biomarkers) intermediate risk group (one protective biomarkers) high risk group (no protective biomarker). Results: After a median of follow-up of 45 months, median OS and RFS were 44 and 9 months respectively. For OS 29(22.66 %), 59(46.09%) and 40(31.25%) patients were in the low, intermediate and high risk group respectively.For RFS 30(23.44%), 52(40.63%) and 46 (35.94%) patients were in the low, intermediate and high risk group respectively. Adjusted Cox regression analysis showed a worse OS survival and RFS increasing risk factors( intermediate group HR 2.67 p=0.007 95%CI 1.31-5.42, high risk group 2.86 p=0.005 95%CI 1.37-5.99 for OS) (intermediate group HR 2.01 p=0.029 95%CI 1.31-3.78, high risk group HR 1.95 p=0.049 95%CI 1.00-3.77 for RFS). Conclusion: Systemic and local immune response index allow to stratify patients in different OS and RFS risk groups.