Scoring of Prognostic Parameters in Patients with Unresectable Advanced or Recurrent Colorectal Cancer Undergoing Chemotherapy

Background

Suitable chemotherapy is needed to prolong the survival of patients with unresectableadvanced or recurrent colorectal cancer. We scored the periodical changes of severalprognostic markers during chemotherapy in patients with this type of cancer to discernthe effectiveness of chemotherapy.

Methods

Twenty consecutive patients with unresectable advanced or recurrent colorectal cancer wereenrolled. All patients underwent combination chemotherapy with oxaliplatin or irinotecan plus5-fluorouracil/leucovorin. Neutrophil/lymphocyte ratio (NLR), serum C-reactive protein (CRP),serum carcinoembryonic antigen (CEA) and serum albumin (ALB) were compared between thetwo periods (before chemotherapy and 3 months after it was started) in each patient.The scoring system was as follows: points are added when a patient shows a decrease of NLR,CRP and CEA and an increase of ALB at 3 months after the start of chemotherapy witha possible final score of +4. On the other hand, points are reduced if a patient shows anelevation of NLR, CRP and CEA and a decrease of ALB at 3 months after the start ofchemotherapy with a possible final score of −4.

Results

At 3 months after the start of first line chemotherapy, 13 patients showed positive scoresbut 7 patients showed zero or minus scores. According to our scoring system, we foundthe mean survival time (MST) of the 13 patients with plus scores was 34 months andthis was significantly better than that of the 7 patients who showed zero or minusscores (P = 0.0008).

Conclusion

Our new scoring system is useful but when we find that first line chemotherapy is ineffective,we need to change it to second line chemotherapy as soon as possible. That may be the besttreatment for patients with unresectable advanced or recurrent colorectal cancer.