Original ResearchThe role of perioperative inflammatory-based prognostic systems in patients with colorectal liver metastases undergoing surgery. A cohort study

- GPS and CAR have been shown to be strong prognostic factors.
- Preoperative GPS>0 predict poor prognosis in colorectal liver metastases patients.
- The prognosis of patients with GPS = 0 could be further stratified by CAR.
- Early postoperative inflammatory prognostic systems may be of limited utility.

BackgroundWe aim to evaluate the prognostic value of preoperative and postoperative inflammatory systems in patients who had undergone surgery for colorectal liver metastases, focusing our analysis on the role of C-reactive protein-to-albumin ratio (CAR) and Glasgow prognostic score (GPS).MethodsA total of 194 patients were enrolled onto this study. Demographics, tumor-related variables, preoperative and postoperative (day 1) inflammatory variables were analyzed as potential prognostic factors.ResultsFor the whole cohort three and 5-year survival were 68% and 53% respectively. Median follow up was 27 months (IQR 10-42). At multivariate analysis only preoperative GPS (HR 12.06, 95% CI 2.82-51.53; p = 0.0008) was an independent risk factor for poor survival. Patients with a preoperative GPS = 0 had a 3-years survival of 70% while it was 33% for those with GPS = 1 (p < 0.0001).In patients with preoperative GPS = 0 preoperative CAR (HR 1.19, 95%CI 1.05-1.35; p = 0.0059) could identify a sub-population at risk for reduced survival. The optimal cut-off for preoperative CAR (preCAR) was 0.133 (HR 7.11 95% CI 1.37-36.78, p = 0.0063). 3-years survival was 75% and 21% for patients with preCAR>0.133 and ≤ 0.133, respectively (p = 0.0005).The immediate postoperative inflammatory status did not have a significant impact on survival.ConclusionGPS is a significant prognostic factor in patients with colorectal liver metastases undergoing surgery. CAR could be a valuable tool to further stratify patients with preoperative GPS = 0 according to their prognosis.