Systemic inflammation, as measured by the neutrophil/lymphocyte ratio, may have differential prognostic impact before and during treatment with fluorouracil, irinotecan and bevacizumab in metastatic colorectal cancer patients

被引:51
作者
Formica, Vincenzo [1 ]
Luccchetti, Jessica [1 ]
Cunningham, David [2 ]
Smyth, Elizabeth C. [2 ]
Ferroni, Patrizia [3 ]
Nardecchia, Antonella [1 ]
Tesauro, Manfredi [4 ]
Cereda, Vittore [1 ]
Guadagni, Fiorella [3 ]
Roselli, Mario [1 ]
机构
[1] Tor Vergata Univ Hosp, Med Oncol Unit, Dept Internal Med, I-00133 Rome, Italy
[2] Royal Marsden Hosp, Gastrointestinal Res Units, Dept Med, Sutton, Surrey, England
[3] IRCCS San Raffaele Pisana, Dept Adv Biotechnol & Bioimaging, Rome, Italy
[4] Tor Vergata Univ Hosp Rome, Dept Internal Med, Rome, Italy
关键词
Neutrophil/lymphocyte ratio; Metastatic colorectal cancer; Bevacizumab; Systemic inflammation; LYMPHOCYTE RATIO; SURVIVAL; NEUTROPHIL; OXALIPLATIN; AVAILABILITY; EXPRESSION; PREDICTOR; CARCINOMA; RESECTION; ANTIBODY;
D O I
10.1007/s12032-014-0166-6
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The inflammatory index neutrophil/lymphocyte ratio (NLR) has an adverse prognostic value in patients with localized colorectal cancer (CRC). We aimed at evaluating its role in metastatic CRC (mCRC) patients treated with standard first-line chemotherapy. Among consecutive CRC patients referred to our Unit, those with metastatic disease eligible for treatment with fluorouracil, irinotecan and bevacizumab (FOLFIRI-Bev) were included in the study. NLR was routinely assessed before each treatment cycle and correlated with outcome together with common clinical, biochemical and histological variables. A sub-analysis focused on patients with stable disease (SD) was also performed to test the net influence of NLR changes independently of tumor shrinkage. At multivariate Cox regression analysis, baseline NLR, taken as continuous variable, was the most powerful prognosticator for survival (HR 1.80, p 0.0019). Surprisingly, among SD patients, the prognostic effect of NLR changes after two cycles of therapy was of opposite sign, and those in whom NLR increased or was maintained had a 67 % reduction in the risk of death as compared with patients with significant NLR decrease: mOS 56 versus 23 months, respectively, p 0.02. In conclusion, we were able to confirm the adverse prognostic value of high baseline NLR for mCRC patients treated with FOLFIRI-Bev. However, FOLFIRI-Bev-induced NLR changes in SD patients seem to differently affect survival. The specific molecular pathways involved in NLR modulation by FOLFIRI-Bev warrant further investigation.
引用
收藏
页码:1 / 8
页数:8
相关论文
共 39 条
[1]   Inflammation and cancer: how friendly is the relationship for cancer patients? [J].
Aggarwal, Bharat B. ;
Gehlot, Prashasnika .
CURRENT OPINION IN PHARMACOLOGY, 2009, 9 (04) :351-369
[2]  
[Anonymous], 2006, American Cancer Society: Cancer Facts and Figures 2006
[3]   Ligand-based targeting of apoptosis in cancer: The potential of recombinant human apoptosis ligand 2/tumor necrosis factor-related apoptosis-inducing ligand (rhApo2L/TRAIL) [J].
Ashkenazi, Avi ;
Holland, Pamela ;
Eckhardt, S. Gail .
JOURNAL OF CLINICAL ONCOLOGY, 2008, 26 (21) :3621-3630
[4]   Inflammation and cancer: back to Virchow? [J].
Balkwill, F ;
Mantovani, A .
LANCET, 2001, 357 (9255) :539-545
[5]   Safety and Activity of Anti-PD-L1 Antibody in Patients with Advanced Cancer [J].
Brahmer, Julie R. ;
Tykodi, Scott S. ;
Chow, Laura Q. M. ;
Hwu, Wen-Jen ;
Topalian, Suzanne L. ;
Hwu, Patrick ;
Drake, Charles G. ;
Camacho, Luis H. ;
Kauh, John ;
Odunsi, Kunle ;
Pitot, Henry C. ;
Hamid, Omid ;
Bhatia, Shailender ;
Martins, Renato ;
Eaton, Keith ;
Chen, Shuming ;
Salay, Theresa M. ;
Alaparthy, Suresh ;
Grosso, Joseph F. ;
Korman, Alan J. ;
Parker, Susan M. ;
Agrawal, Shruti ;
Goldberg, Stacie M. ;
Pardoll, Drew M. ;
Gupta, Ashok ;
Wigginton, Jon M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 366 (26) :2455-2465
[6]   Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer [J].
Chua, W. ;
Charles, K. A. ;
Baracos, V. E. ;
Clarke, S. J. .
BRITISH JOURNAL OF CANCER, 2011, 104 (08) :1288-1295
[7]   An Australian translational Study to evaluate the prognostic role of inflammatory markers in patients with metastatic ColorEctal caNcer Treated with bevacizumab (Avastin™) [ASCENT] [J].
Clarke, Stephen ;
Burge, Matt ;
Cordwell, Cassandra ;
Gibbs, Peter ;
Reece, William ;
Tebbutt, Niall .
BMC CANCER, 2013, 13
[8]   Inflammation and cancer [J].
Coussens, LM ;
Werb, Z .
NATURE, 2002, 420 (6917) :860-867
[9]   An elevated C-reactive protein concentration, prior to surgery, predicts poor cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer [J].
Crumley, A. B. C. ;
McMillan, D. C. ;
McKernan, M. ;
Going, J. J. ;
Shearer, C. J. ;
Stuart, R. C. .
BRITISH JOURNAL OF CANCER, 2006, 94 (11) :1568-1571
[10]   Colorectal cancer in inflammatory bowel disease: What is the real magnitude of the risk? [J].
Dyson, Jessica K. ;
Rutter, Matthew D. .
WORLD JOURNAL OF GASTROENTEROLOGY, 2012, 18 (29) :3839-3848