Introduction:Both localised tumour inflammatory cell infiltrate and a host systemic inflammatory response (SIR) confer prognostic value in colorectal cancer (1, 2, 3). The inter-relationships between components of the SIR and the local inflammatory response are poorly understood. The aim of the present study is to compare the prognostic value of the local inflammatory response (Jass and Klintrup scores) and the SIR (Glasgow Prognostic Score (GPS)), and to examine potential inter-relationships in patients undergoing curative resection for colorectal cancer. Methods: 287 patients underwent curative surgery between 1997-2004. Routine pathology specimens were scored according to Jass and Klintrup criteria for peritumoural infiltrate. Data was collected from routine pre-operative blood tests. To construct the GPS, C-reactive protein >10mg/L and albumin <35g/dl were given a score of 1 and the GPS scored 0, 1 or 2). Hypoalbuminaemia in the absence of CRP>10mg/L was scored 0. Results: Median follow-up was 71 months (minimum 34 months), during this time 116 patients died; 69 of their cancer. On univariate analysis of colon and rectal cancers, the presence of a low grade inflammatory cell infiltrate (Klintrup’s criteria) and a GPS >1 were independently associated with poorer cancer specific survival. In node negative disease (Stage I and II), age (P<0.01), GPS (P<0.01), neutrophil count (p<0.05) and Klintrup criteria (P<0.05) were related to cancer survival. On multivariate survival analysis in node negative disease, the GPS (HR 2.60, P<0.01) and Klintrup criteria (HR 6.35, P<0.05) were independently associated with cancer specific survival. Increasing tumour stage was associated with less peritumoural infiltrate (Jass criteria P<0.001, Klintrup criteria P<0.01). Increased GPS was associated with increased white cell (P<0.01) and neutrophil (P<0.01) counts and low lymphocyte counts (P<0.01). Increased white cell count was associated with increased neutrophil count (P<.001) and low grade peritumoural infiltrate (P<0.05, Klintrup criteria). Jass and Klintrup criteria for peritumoural infiltrate were directly associated (P<0.001). Conclusion: Both pathological (Klintrup) and biochemical (GPS) measures of the inflammatory response are independent predictors of survival following colorectal cancer surgery. Furthermore, the present study’s results suggest low peritumoural infiltrate (Klintrup criteria) and increased systemic inflammation (GPS criteria) are linked by the cell mediated immune system. (1) Jass Jr et al. Lancet 1987;1(8545):1303-6(2) Klintrup K et al. EJC 2005;41:2645-54.(3) Leitch EF et al. Br J Cancer. 2007;97:1266-70.