Inflammation-based markers can predict the prognosis of geriatric patients with metastatic colorectal cancer receiving first-line chemotherapy

Guifang Guo, Xiuxing Chen, Xiuyu Cai, Yanfeng Chen, Haohua Wang, Lei Fan, Long Bai, Huijuan Qiu, Bei Zhang


Background: Relationship between inflammatory factors and survival or efficacy of first-line treatment in elderly patients with metastatic colorectal cancer (MCRC) who received first-line chemotherapy has not been clarified.
Methods: A total of 186 MCRC patients aged ≥65 years, receiving chemotherapy between January 1, 2004 and October 1, 2015 were identified. Pretreatment levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), lactate dehydrogenase (LDH), C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were measured. Effect of these inflammatory factors on overall survival (OS) and first-line progression-free survival were analyzed.
Results: Median age was 72 years. Median PFS and OS were 6.70 months and 25.62 months. CEA ≥85 ng/mL (P=0.010), CA 19-9 ≥32.97 U/mL (P=0.010), LDH ≥325 U/L (P=0.015), CRP ≥11 mg/L (P=0.004) and NLR ≥2.12 (P=0.045) were associated with poor OS. Furthermore, LDH (P=0.025) was demonstrated as an independent prognostic factor of OS for all patients, so did the combination of CEA with CA 19-9 (P=0.009). When predicting the one, three and five-year survival, combination of CEA with CA 19-9 had higher sensitivity compared with CEA alone or CA 19-9 alone respectively. For right-sided colon cancer, CEA (P<0.001) and CA 19-9 (P=0.003) were related with OS and CEA (P=0.002) was the independent prognostic factor. For left-sided colorectal cancer, inflammatory factors related with OS were LDH (P=0.039), CRP (P=0.004) and NLR (P=0.020) and CRP (P=0.040) was the independent prognostic factor. Only high level CA19-9 (≥32.97 U/mL P=0.024) was related with decreased PFS in univariate analysis. However, no inflammatory factors were contained in multivariate COX regression.
Conclusions: CEA, CA 19-9, LDH, CRP and NLR were related with OS in geriatric patients with MCRC. Right-sided and left-sided groups had different independent prognostic markers, CEA and CRP respectively.