The relationship between systemic inflammatory response, screen detection and outcome in colorectal cancer

Abstract Aim A raised systemic inflammatory response correlates with poorer colorectal cancer (CRC) outcomes. Faecal immunochemical test bowel screening aims to detect early‐stage disease. We assessed the relationship between systemic inflammatory response, screen detection and CRC survival. Method A retrospective, observational cohort study compared screen‐detected and non‐screen‐detected CRC patients undergoing resection. Systemic inflammatory response was measured using lymphocyte/monocyte, neutrophil/lymphocyte and platelet/lymphocyte ratios (LMR, NLR, PLR). Covariables were compared using χ 2 testing and survival with Cox regression. Results A total of 761 patients were included (326 screen‐detected, 435 non‐screen‐detected). Screen‐detected patients had lower systemic inflammatory response: low (<2.4) LMR (28.8% vs. 44.6%; P < 0.001), moderate (3–5) or high (>5) NLR (26.1% vs. 30.6%, P < 0.001; and 7.7% vs. 19.5%, P < 0.001) and high (>150) PLR (47.2% vs. 64.6%; P < 0.001). Median follow‐up was 63 months. On univariate analysis, non‐screen detection (hazard ratio [HR] 2.346, 95% CI 1.687–3.261; P < 0.001), advanced TNM ( P < 0.001), low LMR (HR 2.038, 95% CI 1.514–2.742; P < 0.001), moderate NLR (HR 1.588, 95% CI 1.128–2.235; P = 0.008), high NLR (HR 2.382, 95% CI 1.626–3.491; P < 0.001) and high PLR (HR 1.827, 95% CI 1.326–2.519; P < 0.001) predicted poorer overall survival (OS). Non‐screen detection (HR 2.713, 95% CI 1.742–4.226; P < 0.001), TNM ( P < 0.001), low LMR (HR 1.969, 95% CI 1.340–2.893; P < 0.001), high NLR (HR 2.368, 95% CI 1.448–3.875; P < 0.001) and high PLR (HR 2.110, 95% CI 1.374–3.240; P < 0.001) predicted poorer cancer‐specific survival (CSS). On multivariate analysis, non‐screen detection (HR 1.698, 95% CI 1.152–2.503; P = 0.008) and low LMR (HR 1.610, 95% CI 1.158–2.238; P = 0.005) independently predicted poorer OS. Non‐screen detection (HR 1.847, 95% CI 1.144–2.983; P = 0.012) and high PLR (HR 1.578, 95% CI 1.018–2.444; P = 0.041) predicted poorer CSS. Conclusion Screen‐detected CRC patients have a lower systemic inflammatory response. Non‐screen detection and systemic inflammatory response (measured by LMR and PLR respectively) were independent predictors of poorer OS and CSS.