https://orcid.org/0000-0001-5683-6315
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Abstract
Post-operative inflammation in cancer patients can be modulated by drugs and diets, but evidence on its prognostic role, which would be crucial for personalized treatment and surveillance schemes, remains rather limited. We aimed to systematically review and meta-analyse studies on the prognostic value of post-operative C-reactive protein (CRP)-based inflammatory biomarkers among patients with colorectal cancer (CRC) (PROSPERO#: CRD42022293832). PubMed, Web of Science and Cochrane databases were searched until February 2023. Studies reporting associations between post-operative CRP, Glasgow Prognostic Score (GPS) or modified Glasgow Prognostic Score (mGPS) with overall survival (OS), CRC-specific survival (CSS) and recurrence-free survival (RFS) were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the predictor-outcome associations were pooled using R-software, version 4.2. Sixteen studies (n = 6079) were included in the meta-analyses. Elevated post-operative CRP was a predictor of poor OS, CSS and RFS compared with low CRP levels [HR (95% CI): 1.72 (1.32–2.25); 1.63 (1.30–2.05); 2.23 (1.44–3.47), respectively]. A unit increase in post-operative GPS predicted poor OS [HR (95% Cl): 1.31 (1.14–1.51)]. Moreover, a unit increase in post-operative mGPS was associated with poor OS and CSS [HR (95% Cl): 1.93 (1.37–2.72); 3.16 (1.48–6.76), respectively]. Post-operative CRP-based inflammatory biomarkers have a significant prognostic role for patients with CRC. Prognostic value of these easy-to-obtain routine measurements thereby seems to outperform most of the much more complex blood- or tissue-based predictors in the current focus of multi-omics-based research. Future studies should validate our findings, establish optimal time for biomarker assessment and determine clinically useful cut-off values of these biomarkers for post-operative risk-stratification and treatment-response monitoring.
Abbreviations
CRC, Colorectal cancer; CRP, C-reactive protein; CSS, Colorectal cancer-specific survival; GPS, Glasgow Prognostic Score; HR, Hazard Ratio; IL, Interleukin; mGPS, Modified Glasgow Prognostic Score; MOOSE, Meta-analyses of observational studies in epidemiology; OS, Overall survival; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QUIPS, Quality In Prognosis Studies; RFS, Recurrence-free survival; TNF-α, Tumor necrosis factor-alpha; TNM, Tumor node metastasis; 95% CI, 95% confidence interval.
Data Sharing Statement
All data generated or analysed during this study are included in this published article [and its Supplementary Information Files].
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Dr Dominic Edelmann reports Lecture fees from Pfizer, outside the submitted work. Prof. Dr. Hermann Brenner reports grants from German Federal Ministry of Education and Research, during the conduct of the study. The authors declare that they have no other financial or non-financial competing interests.