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

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  • Gabor Liposits
  • Halla Skuladottir
  • Jesper Ryg
  • Stine Brændegaard Winther
  • Møller, Søren
  • Eva Hofsli
  • Carl Henrik Shah
  • Laurids Østergaard Poulsen
  • Åke Berglund
  • Camilla Qvortrup
  • Pia Osterlund
  • Johansen, Julia Sidenius
  • Bengt Glimelius
  • Halfdan Sorbye
  • Per Pfeiffer

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
Antal sider15
ISSN2077-0383
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This investigator-initiated study was partly funded by: Taiho Pharmaceuticals, Nordic Group; The Danish Cancer Society (grant number: R269-A15859); Academy of Geriatric Cancer Research (AgeCare); The Swedish Cancer Society; Region of Southern Denmark.

Publisher Copyright:
© 2022 by the authors.

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