The effect of systemic inflammation on locoregional colon cancer recurrence

Abstract

Curative-intent treatment fails to prevent recurrence in a significant proportion of patients with locoregional colon cancer. Systemic inflammation plays a critical role in colorectal cancer progression. We evaluated the association between preoperative systemic inflammatory markers and distant disease-free survival (DDFS) in stage II and III colon cancer to identify independent prognostic indicators. In this retrospective, single-center study, 299 patients with stage III or high-risk stage II colon cancer who underwent curative R0 resections and completed adjuvant chemotherapy (2013–2019) were evaluated. Preoperative hematological parameters, biochemical markers (albumin, CRP, LDH), and immunonutritional indices (PNI, GPS) were assessed. The primary outcome was distant disease-free survival (DDFS). Survival curves were analyzed using Kaplan–Meier methods, and independent prognostic factors were identified using multivariable Cox proportional hazards regression. Preoperative high neutrophil count, high leukocyte count, low lymphocyte count, and low serum albumin level were significantly associated with lower DDFS rates (82.5% vs. 70.9%, p = 0.035; 82.2% vs. 66.6%, p = 0.030; 84.9% vs. 70.6%, p = 0.005; and 83.7% vs. 73.5%, p = 0.040, respectively). On multivariable Cox analysis, high leukocyte count (HR = 1.928, 95% CI 1.080–3.440, p = 0.026), high neutrophil count (HR = 2.135, 95% CI 1.076–4.236, p = 0.030), low lymphocyte count (HR = 2.344, 95% CI 1.376–3.993, p = 0.002), low serum albumin (HR = 2.170, 95% CI 1.280–3.680, p = 0.004), and low PNI score (HR = 1.05, 95% CI 1.007–1.090, p = 0.022) remained independent predictors of recurrence. Our study suggests that patients with an increased preoperative inflammatory response—characterized by elevated leukocyte and neutrophil counts, reduced lymphocyte counts, or low serum albumin levels and PNI scores—may be at a higher risk of recurrence.