*Michał Nycz, Jakub Kropieniewicz, Kamil Suliga, Tomasz Zawadzki, Mieszko Norbert Opiłka, Zbigniew Lorenc
Peripheral blood inflammatory parameters in patients with colorectal cancer
Parametry zapalne w krwi obwodowej u chorych z rakiem jelita grubego
Department of General, Colorectal and Multiple-Organ Surgery, Faculty of Health Sciences, Medical University of Silesia in Katowice, St. Barbara Specialist Province Hospital no. 5 in Sosnowiec
Head of Department: Professor Zbigniew Lorenc, MD, PhD
Wstęp. Rak jelita grubego jest trzecim najczęściej występującym nowotworem w populacji światowej. Zastosowanie coraz nowocześniejszych metod diagnostycznych i terapeutycznych powoduje spadek umieralności. Pomimo tego co roku notuje się większy odsetek zachorowalności. Parametry zapalne odgrywają istotną rolę podczas nowotworzenia – w wielu aspektach oba procesy są ze sobą połączone.
Cel pracy. Celem pracy jest przedstawienie dodatniej korelacji pomiędzy CRP i poziomem leukocytów we krwi obwodowej u chorych z RJG oraz ich porównanie z wynikiem histopatologicznym oceniającym naciek nowotworu na okoliczne tkanki lub jego brak.
Materiał i metody. Badaniem objęto 50 chorych z RJG. Czynnikami wykluczającymi były m.in. przerzuty odległe, terapia neoadjuwantowa oraz przeszłość nowotworowa. Pacjenci zostali podzieleni na dwie grupy: z naciekiem nowotworowym na okoliczne tkanki oraz bez niego.
Wyniki. U wszystkich chorych objętych badaniem zaobserwowano podwyższony poziom CRP. W grupie z naciekiem nowotworowym na okoliczne tkanki wskaźnik ten był wyższy, ale nieznamienny statystycznie. Dodatkowo w obu grupach poziom leukocytów nie przekraczał normy populacyjnej. Interesującym jest fakt, że w grupie z naciekiem nowotworowym na okoliczne tkanki poziom ten był niższy, a wartość ta okazała się być znamienna statystycznie.
Wnioski. Poziom CRP i leukocytów krwi obwodowej może być pomocny jako dodatkowy wskaźnik oceniający stopień klinicznego zaawansowania nowotworu. Ogólna dostępność i niskie koszty powyższych badań przemawiają za możliwością stosowania ich w codziennej praktyce. Obniżony poziom leukocytów u chorych z bardziej zaawansowanym procesem nowotworowym zostanie poddany dalszym badaniom.
Introduction. Colorectal cancer is the third most common cancer worldwide. The introduction of novel diagnostic and treatment methods has resulted in decreasing mortality rates; however, an increase in morbidity is observed. Severe inflammation plays an important role in many aspects associated with carcinogenesis. Neoplasia and inflammatory response are mutually related.
Aim. The aim of the study was to evaluate the association between preoperative serum C-reactive protein levels and total leukocyte count in colorectal cancer patients in comparison with postoperative histopathological findings depending on whether there was neoplastic infiltration of the local adipose tissue or not.
Material and methods. The study population included 50 patients with colon cancer. Exclusion criteria were distant metastases, neoadjuvant therapy and a past history of cancer diagnosis. Blood findings were compared with histopathology. Patients were divided into two groups – with and without neoplastic infiltration of fat tissue in histopathology.
Results. Serum C-reactive protein levels were evaluated in all patients. The tested indicator was higher in the group with infiltration, but was not statistically significant. Additionally, the WBC count was normal in both groups, but it was lower in the group with infiltration, and the result was statistically significant.
Conclusions. C-reactive protein level and total leukocyte count can be a helpful and supportive marker in staging in colorectal cancer patients. Owing to the wide availability and low cost of the above mentioned blood tests, they may be easily performed in daily medical practice. The decrease in the total leukocyte count was proportional with higher cancer stage; therefore, it needs to be further investigated.
Słowa kluczowe: RJG, parametry zapalne, wskaźnik prognostyczny
Key words: CRC, inflammatory parameters, prognostic indicator
Colorectal cancer (CC), which is the third most commonly diagnosed cancer and the fourth leading cause of cancer-related death globally, has become an important social problem (1). The introduction of novel diagnostic and therapeutic methods, such as combined surgical and anticancer treatment, including biological targeted therapy, has reduced mortality rates; however, since the number of newly diagnosed cases is increasing, new treatment strategies are continuously sought (2, 3). Despite the use of many determinants, with the UICC TNM staging system being the most important tool due to the varying survival time observed among patients with the same stage of disease, more sensitive markers, which will enable the introduction of appropriate, patient-tailored treatment, are still sought (4).
The extent of neoplastic infiltration and lymph node involvement are still considered one of the key prognostic factors (3). Chronic inflammation plays an important role in many aspects related to carcinogenesis, including all its stages, and affects the clinical picture (5). There is a link between neoplasia and inflammatory response: tumors may develop secondary to inflammation, and their growth may itself lead to the development of inflammatory microenvironments (6). There are a number of commonly used parameters for the evaluation of inflammatory processes, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and neutrophil/lymphocyte ratio (NLR) (7).
CRP is an acute phase protein produced in the liver, the expression of which is increased in inflammatory processes, promoted by the state of hypercytokinemia, increased expression of interleukins (IL)-1, IL-6 and tumour necrosis factor (TNF). The same cytokines promote tumour growth and distant metastases, and therefore play the key role in neoplastic processes (4). Changes in CRP as an inflammatory marker have been associated with the growth of many tumors, such as breast, endometrial, prostate, and ovarian cancer; however, the strongest correlations were reported for lung and colorectal cancer (8). So far, however, it has not been possible to demonstrate beyond any doubt whether the increase in CRP should be associated with the direct involvement of this protein in carcinogenesis, or whether it is only a marker of the processes involved (6). Studies in large samples using sensitive methods have shown that the increased expression of this protein is typical not only for patients with already developed cancer, but also for healthy individuals at an increased risk of cancer (6). It should be noted, however, that increased serum CRP levels were also linked to adenomas with a high risk of transformation to CC (9, 10). The above observations ale also confirmed by the evident reduction in the risk of CC due to the use of nonsteroidal anti-inflammatory drugs (8, 11).
It seems that significantly less literature reports discuss the phenomenon of increased WBC counts in the aspect of CC carcinogenesis. Ghuman et al. presented a hypothesis according to which leukocytosis is accompanied by oxygen explosion, which is associated with a sudden release of reactive oxygen species from the cell, which in turn may cause DNA damage leading to neoplastic transformation (12).
The aim of the study was to assess the correlation between peripheral blood CRP and WBC in patients with primary colorectal cancer and postoperative histology findings for the presence or absence of neoplastic infiltration of local tissues.
Material and methods
A total of 50 patients with colon cancer who were surgically treated in the Department of General, Colorectal and Multiple-Organ Surgery of the Medical University of Silesia in the period of 18 months between 2017 and 2018 were included in the study.
Inclusion criteria were age < 75 years, no cancer history or cancer dissemination to parenchymatous and peritoneal organs. Neoadjuvant therapy was also an exclusion criterion.
A total of 25 women and 25 men were qualified to this group. A total of 48 patients were admitted and underwent elective surgeries following diagnostic imaging (abdominal and pelvic CT) and diagnostic endoscopy with histopathological confirmation of cancer. Two patients underwent an urgent surgery due to life-threatening GI obstruction – no diagnostic endoscopy was performed in this small group, and the diagnosis of cancer was based on postoperative histopathological evaluation.
Laboratory samples were collected the day before surgical procedure. In addition to standard blood cell count, which importantly included WBC, CRP levels were measured. Additionally, nutritional parameters (protein, albumins, cholesterol) were measured and general condition was assessed based on the Karnofsky scale.
Histopathology involved an assessment of the tumour according to the TNM staging system, tumour ulceration, the number of sampled lymph nodes and the number of involved lymph nodes. Additionally, attention was paid to histological grade, the presence of tumour necrosis, neuronal infiltration, lymphatic/blood vessels, and oncological purity at the site of bowel separation from the mesentery.
A questionnaire to collect general information was completed by the physician responsible for treatment qualification during interviews with patients in order to increase the reliability of the results obtained.
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