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A Novel Sierological Inflammatory Score As Possible Prognostic Marker in Colorectal Cancer
Giuseppe Di Caro*3, Michele Carvello1, Samantha Pesce3, Matteo Sacchi1, Marco Erreni3, Federica Marchesi3, Paola Allavena3, Marco Montorsi1, Antonino Spinelli1, 2
1Department of General and Digestive Surgery, Humanitas Research Hospital, Rozzano Milano, Italy; 2University of Milano, Milano, Italy; 3Department of Inflammation and Immunology, Humanitas Research Hospital, Rozzano Milano, Italy
Objectives: In this study we aim to find a correlation between preoperative peripheral immune response and long term oncologic outcome of colorectal cancer (CRC) patients undergoing surgery.
Background data: CRC is still associated with high mortality rates in advanced stage and recurrent disease. The use of non-invasive, cost-effective and highly sensitive tests is advocated to identify patients at high risk of recurrence. Local inflammatory cytokine networks are involved in tumor progression, metastasis and angiogenesis. There is evidence that perioperative alteration of the immune status may worsen the oncological outcome and the overall survival of CRC patients.
Methods: Peripheral cytokines levels including IL-1, IL-6, IL-10, TNFα, CCL2, CXCL8, VEGF and acute phase protein Pentraxin-3, were prospectively measured by ELISA assay in preoperative serum samples in 63 patients diagnosed with stage I-IV CRC and correlated with postoperative disease recurrence and overall survival.
Results: At Kaplan-Meier analysis it was confirmed that higher CXCL8, VEGF and Pentraxin-3 levels were significantly associated with poor outcome (P<0.001). At Cox multivariate analysis, we developed a cytokine score combining high levels of CXCL8, VEGF and Pentraxin-3 (IST: immune serum-based screening test) that is associated to increased risk of developing disease recurrence [HR:14.28;95%; CI:3.13-65.1] regardless from TNM staging and other histopathological variables.
Conclusions: IST cytokines score is effective in predicting postoperative CRC patient's outcome possibly reflecting the ongoing inflammatory reaction at the tumor site. Further larger studies are needed to support the use of serum cytokine scores in clinical practice to improve CRC patients'outcomes.
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