Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2016; 8(8): 623-628
Published online Aug 15, 2016. doi: 10.4251/wjgo.v8.i8.623
Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma
Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick
Rory P Kennelly, Brenda Murphy, John O Larkin, Brian J Mehigan, Paul H McCormick, Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland
Author contributions: Kennelly RP and Murphy B drafting, study design, data collection; Larkin JO, Mehigan BJ and McCormick PH concepted this study, drafting and editing.
Institutional review board statement: The local institutional review board did not require ethics review for a retrospective anonymised dataset.
Informed consent statement: N/A, it is a retrospective anonymised dataset.
Conflict-of-interest statement: The authors declare no conflict of interest in writing this manuscript.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Rory P Kennelly, Department of Colorectal Surgery, St. James Hospital, James’s Street, Dublin 8, Ireland. rorykennelly@rcsi.ie
Telephone: +353-87-9458963 Fax: +353-1-4103400
Received: January 8, 2016
Peer-review started: January 9, 2016
First decision: February 26, 2016
Revised: April 6, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 15, 2016
Processing time: 214 Days and 5.3 Hours
Abstract

AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer.

METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio (NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ2 tests where appropriate.

RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9 (P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio (≥ 0.25, P = 0.044).

CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.

Keywords: Systemic inflammatory response; Lymph node yield; Lymph node count; Colon cancer; Colonic cancer; Neutrophil-lymphocyte ratio; Neutrophil to lymphocyte ratio; Lymph node ratio

Core tip: A fascinating field of research is the relationship between systemic inflammatory response and loco-regional inflammatory response in colorectal cancer. This manuscript examines this relationship in a large cohort of patients from a tertiary referral centre. We measured systemic response by assessing serum markers at diagnosis and we measured local response by looking at pathological lymph node counts in the post operative surgical specimen. This is the first report to show that patients with evidence of an activated systemic inflammatory response at diagnosis have a reduced nodal harvest at time of surgery. This finding sheds light on the complex interaction between cancer and the patient. This host-tumour response forms the basis for the most advanced cancer research today.