Research Papers:

Inflammatory biomarkers in metastatic colorectal cancer: prognostic and predictive role beyond the first line setting

Jakob Michael Riedl, Florian Posch, Florian Moik, Angelika Bezan, Joanna Szkandera, Maria Anna Smolle, Anne-Katrin Kasparek, Martin Pichler, Herbert Stöger, Michael Stotz _ and Armin Gerger

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Oncotarget. 2017; 8:96048-96061. https://doi.org/10.18632/oncotarget.21647

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Jakob Michael Riedl1, Florian Posch1, Florian Moik1, Angelika Bezan1, Joanna Szkandera1, Maria Anna Smolle1, Anne-Katrin Kasparek1, Martin Pichler1,3, Herbert Stöger1, Michael Stotz1 and Armin Gerger1,2

1Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria

2Center for Biomarker Research in Medicine, 8010 Graz, Austria

3Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA

Correspondence to:

Michael Stotz, email: [email protected]

Keywords: biomarker, inflammation, metastatic, colorectal cancer, palliative chemotherapy

Received: July 05, 2017     Accepted: August 08, 2017     Published: October 04, 2017


Introduction: Inflammatory 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.

Results: In 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)).

Methods: Two-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.

Conclusion: This study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in mCRC patients.

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