Prognostic and predictive value of systemic and intra-tumor inflammation markers in early stage colon cancer cases

The aim of this study is to investigate the prognostic and predictive effects of systemic and local inflammation markers in patients with early stage colon cancer, and to evaluate the effect of these two markers on prognosis and chemotherapy responses. This study included 304 patients who were admitted to Hacettepe University Medical Oncology Department after curative resection, diagnosed between January 2008 and January 2016, who were stage 2-3, and who were 18 years and older at the time of diagnosis. Preoperative Neutrophil-lymphocyte ratio (NLR), albumin-NLR score, systemic immune inflammation index (SII) and panimmun inflammation value (PIV) was evaluated as systemic inflammation markers. The density of CD8 lymphocytes in the tumor periphery and center of the tumor tissues of the patients was divided into two as low or high density compared to the 75th percentile. Combined inflammation score (CIS) was classified as high risk in patients with high PIV and low CD8 density, and low risk in other patients. High albumin-NLR score and high PIV were associated with shorter DFS and OS. Low mean CD8 density was found to be associated with short DFS. Higher combined inflammation score was found to be associated with both shorter OS and shorter DFS. It was observed that adjuvant chemotherapy significantly increased DFS in patients with high CIS in stage 2 patients. Adjuvant chemotherapy did not contribute to DFS in patients with low CIS. In multivariate analysis for disease free survival; ≥ 65 years old age (HR: 3.12 95% CI 1.78-5.48, p <0.001), stage 3 disease (HR: 1.82 95% CI 1.06-3.12, p = 0.029), higher combined inflammation score (HR: 3.82 95% CI 2.21-6.61, p <0.001) was found to be associated with shorter DFS. The combined inflammation score we described in this study is associated with a poor prognosis regardless of age and stage. In addition, it has been observed that it may have predictive value for the contribution of chemotherapy in stage 2 patients. The combined inflammation score can be used as a new marker predicting prognostic and chemotherapy response in patients with early stage colon cancer.