The prognostic value of pre-treatment circulating biomarkers of systemic inflammation (CRP, dNLR, YKL-40, and IL-6) in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy — The randomized NORDIC9-study

Gabor Liposits, Halla Skuladottir, Jesper Ryg, Stine Brændegaard Winther, Sören Möller, Eva Hofsli, Carl-Henrik Shah, Laurids Østergaard Poulsen, Åke Berglund, Camilla Qvortrup, Pia Osterlund, Julia S. Johansen, Bengt Glimelius, Halfdan Sorbye, Per Pfeiffer

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Abstrakt

Appropriate patient selection for palliative chemotherapy is crucial in patients with metastatic colorectal cancer (mCRC). We investigated the prognostic value of C-reactive protein (CRP), derived neutrophil-to-lymphocyte ratio (dNLR), Interleukin (IL)-6, and YKL-40 on progression-free survival (PFS) and overall survival (OS) in the NORDIC9 cohort. The randomized NORDIC9-study included patients ≥70 years with mCRC not candidates for standard full-dose combination chemotherapy. Participants received either full-dose S1 (Teysuno) or a dose-reduced S1 plus oxaliplatin. Blood samples were collected at baseline and biomarkers were dichotomized according to standard cut-offs. Multivariable analyses adjusted for age, sex, ECOG performance status, and treatment allocation; furthermore, C-statistics were estimated. In total, 160 patients with a median age of 78 years (IQR: 76–81) were included between 2015 and 2017. All investigated biomarkers were significantly elevated in patients with either weight loss, ≥3 metastatic sites, or primary tumor in situ. In multivariable analyses, all markers showed significant association with OS; the highest HR was observed for CRP (HR = 3.40, 95%CI: 2.20–5.26, p < 0.001). Regarding PFS, statistically significant differences were found for CRP and IL-6, but not for dNLR and YKL-40. Applying C-statistics, CRP indicated a good prognostic model for OS (AUC = 0.72, 95%CI: 0.67–0.76). CRP is an easily available biomarker, which may support therapeutic decision-making in vulnerable older patients with mCRC.
OriginalsprogEngelsk
Artikelnummer5603
TidsskriftJournal of Clinical Medicine
Vol/bind11
Udgave nummer19
ISSN2077-0383
DOI
StatusUdgivet - 23. sep. 2022

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  • Nordic9-study

    Liposits, G. I., Pfeiffer, P., Winther, S. B., Ryg, J. & Skuladottir, H.

    01/09/202031/08/2023

    Projekter: ProjektPh.d-projekt

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