Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis
by
,
Troels Gammeltoft Dolin
1,*
,
Ib Jarle Christensen
2,
Astrid Zedlitz Johansen
3,
Hans Jørgen Nielsen
2,†,
Henrik Loft Jakobsen
4,
Mads Falk Klein
4,
Cecilia Margareta Lund
1,5,
Stig Egil Bojesen
5,6,
Dorte Lisbeth Nielsen
3,5,
Benny Vittrup Jensen
3 and
Julia Sidenius Johansen
1,3,5 1
Department of Medicine, Copenhagen University Hospital, DK-2730 Herlev, Denmark
2
Department of Gastrointestinal Surgery, Copenhagen University Hospital, DK-2650 Hvidovre, Denmark
3
Department of Oncology, Copenhagen University Hospital, DK-2730 Herlev, Denmark
4
Department of Surgery, Copenhagen University Hospital, DK-2730 Herlev, Denmark
5
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
6
Department of Clinical Biochemistry, Copenhagen University Hospital, DK-2730 Herlev, Denmark
*
Author to whom correspondence should be addressed.
†
Deceased.
Cancers 2022, 14(1), 161; https://doi.org/10.3390/cancers14010161
Submission received: 29 October 2021
/
Revised: 11 December 2021
/
Accepted: 24 December 2021
/
Published: 29 December 2021
Simple Summary
Colorectal cancer is the second most common cancer worldwide, and the incidence increases with age. The primary treatment for localized disease is surgical resection. Biomarkers identifying older patients at risk of complications following surgery are desirable to create a more individualized treatment plan. The purpose of this study is to investigate if circulating proteins related to inflammation (CRP, Il-6, and YKL-40) can provide information about the risk of complications and survival in older patients undergoing resection, and, furthermore, to investigate if this relation is different in older patients as compared to younger patients. We investigated 401 patients with localized colorectal cancer and found that older patients (n = 210) had higher levels of preoperative inflammatory biomarkers compared to younger patients (n = 191). High levels were associated with major complications after resection in older, but not in younger, patients. This may be useful in the future to design more personalized treatment plans.
Abstract
The association between pre- and perioperative inflammatory biomarkers, major complications, and survival rates after resection of colorectal cancer (CRC) in older patients is largely unknown. The aim was to investigate age-dependent differences in these associations. Serum CRP, IL-6, and YKL-40 were measured preoperatively and on the first and second day after resection of CRC (stages I–III) in 210 older (≥70 years) and 191 younger patients (<70 years). The results from the complications was presented as an odds ratio (OR, with a 95% confidence interval (CI)) with logistic regression. Results from the mortality rates were presented as a hazard ratio (HR, with a 95% CI) using Cox proportional hazards regression. The preoperative inflammatory biomarkers were higher in the older vs. the younger patients. The risk of complications was increased in older patients with a high preoperative CRP (OR = 1.25, 95% CI 1.03–1.53), IL-6 (OR = 1.57, 95% CI 1.18–2.08), and YKL-40 (OR = 1.66, 95% CI 1.20–2.28), but not in younger patients. Mortality was higher in younger patients with high preoperative YKL-40 (HR = 1.66, 95% CI 1.06–2.60). This was not found in older patients. Elevated preoperative inflammatory biomarkers among older patients were associated with an increased risk of complications, but not mortality. Preoperative inflammatory biomarkers may be useful in assessing the risk of a complicated surgical course in older patients with CRC.
Keywords:
ageing; CRP; colorectal cancer; complications; inflammation; IL-6; inflammatory biomarkers; surgery; YKL-40
