The impact of postoperative inflammation on recurrence in patients with colorectal cancer
The impact of postoperative inflammation on recurrence in patients with colorectal cancer
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DOI：
10.1007/s10147-019-01580-1
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发表时间：
2019-11-22
影响因子：
3.3
通讯作者：
Otsuji, Eigo
中科院分区：
文献类型：
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作者：
Matsubara, Daiki;Arita, Tomohiro;Otsuji, Eigo
背景全身炎症反应与肿瘤的发生、发展和预后不良密切相关。本研究旨在探讨结直肠癌患者术后血清C-反应蛋白(CRP)水平对患者预后的影响。方法对467例I-III期结直肠癌根治性手术患者的临床资料进行回顾性分析。为了准确评估结直肠癌患者术后炎症状态对预后的影响，我们排除了术后并发症或术前C反应蛋白水平升高的患者(CRP和GT；1.0 mg/dL)。根据术后最高C反应蛋白水平分为低C反应蛋白组和高C反应蛋白组，低C反应蛋白组385例，高C反应蛋白组82例。此外，采用体外腹膜扩散模型评价炎症对结直肠癌细胞恶性潜能的影响。结果HCG组的无复发生存率明显低于LCG组(P=0.012)。多因素分析显示，最大C反应蛋白升高是RFS的独立预后因素(HR：2.07，95%CI1.04~3.96，P=0.038)。多因素分析显示，高龄(p<；0.001)、男性(p<；0.001)、高体重指数(p=0.005)、右侧结直肠癌(p=0.008)、手术时间较长(p=0.007)是高危因素。较高的最大C反应蛋白水平也与腹膜复发显著相关(p<；0.001)。此外，重组细胞因子在体外可增强结直肠癌细胞与间皮细胞的黏附能力(p<；0.05)。结论术后炎症可能是结直肠癌患者预后不良的可能机制之一。
Background Systemic inflammatory response is strongly linked to among cancer development, progression and poor prognosis. The aim of this study was to clarify the impact of postoperative serum C-reactive protein (CRP) levels on the prognoses of patients with colorectal cancer (CRC). Methods A total of 467 patients with stage I-III CRC who underwent curative surgery were retrospectively analyzed. To precisely evaluate the effect of postoperative inflammatory status on prognosis in CRC patients, we excluded patients with postoperative complication or elevated preoperative CRP level (CRP > 1.0 mg/dL). Patients were divided into two groups based on their highest post-resection CRP levels (max CRP): the low CRP group (LCG; < 9.0 mg/dL, n = 385) and high CRP group (HCG; >= 9.0 mg/dL, n = 82). Furthermore, the effect of inflammation on malignant potential of CRC cells was evaluated using in vitro peritoneal dissemination model. Results HCG patients showed significantly worse recurrence-free survival (RFS) than LCG patients (p = 0.012). Multivariate analysis revealed that a higher max CRP was an independent prognostic factor for RFS (HR: 2.07, 95% CI 1.04-3.96, p = 0.038). Concerning the risk factors for high max CRP level, multivariate analysis revealed that older age (p < 0.001), male sex (p < 0.001), higher BMI (p = 0.005), right-sided colorectal cancer (p = 0.008), and longer operative time (p = 0.007) were independent risk factors. A higher max CRP was also significantly associated with peritoneal recurrence (p < 0.001). Additionally, recombinant cytokines enhanced the adhesive ability of CRC cells to mesothelial cell in vitro (p < 0.05). Conclusions Postoperative inflammation may be a possible mechanism portending the poor prognosis of CRC patients.