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

Background: We 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).

Methods: A 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.

Results: For 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.

Conclusion: GPS 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.