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Chronic inflammation is an aberrantly prolonged form of a protective response to a loss of tissue homeostasis and it is involved in several steps of the carcinogenesis process. As a result, many cancers are inflammation-related. The systemic inflammatory response is associated with survival in advanced and localized cancers. Two categories of scores have been proposed to monitor the systemic inflammatory response, those derived from protein measurement and those based on counting inflammatory cells. This review aims to provide a critical appraisal of these 2 categories of surrogate markers. The 3 scale modified Glasgow prognostic score (mGPS) is based on the combination of C-reactive protein and albumin and is graded 0 to 2. It has been validated worldwide showing an independent prognostic value in patients with cancer in a variety of tumour types and tumour stages. Leukocytes-based scores are mainly neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Elevated NLR and/or PLR and lower LMR seem to be associated with decreased survival, but the studies about these markers are very heterogeneous. The main limit is the variety of thresholds used to dichotomize patients, so that reproducibility and reliability of leukocytes-based scores can be questioned. Hence, there is no sufficient evidence to support their use in clinical practice. Comprehensive management of patients with operable and advanced cancer should integrate the host systemic inflammatory response by calculating the mGPS. It could be a helpful tool to tailor patients' management. [ABSTRACT FROM AUTHOR]

Background Liver-limited recurrence after resection of colorectal liver metastases is a frequent occurrence, and can in some cases be treated with curative intent. Although surgical re-resection remains standard of care, there is growing interest in the role of ablation in this setting. The aim of this study was to compare the outcomes after curative-intent ablation and resection in patients with recurrent colorectal liver metastases. Methods We retrospectively analysed data from 366 consecutive patients who underwent liver resection for colorectal liver metastases between June 2010 and August 2015. Sixty-four developed liver-limited recurrence which was treated with curative intent, thirty-three (51.6%) by ablation and 31 (48.4%) by repeat resection. Results Patient groups were well matched, with surgically resected patients showing higher pre-operative carcinoembryonic antigen levels and larger metastases. There were fewer post-operative complications and shorter length of stay in the ablation group (p < 0.02). After a median follow-up of 36.2 months, median overall survival was the same for both the resected and ablated groups at 33.3 months. Median progression-free survival was longer for patients treated with surgery (10.2 months) compared to ablation (4.3 months) (p = 0.002). Conclusions Ablation or resection for liver-limited recurrence after surgery for colorectal liver metastases is associated with improved overall survival compared with systemic chemotherapy alone, and should always be considered for patients with resectable liver recurrence. Although ablation seemed to be associated with a shorter progression-free survival, post-procedure morbidity was significantly lower. The choice between ablation and resection should therefore be made on a personalised basis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hepatic steatosis (HS) is as an independent risk factor for morbidity and mortality post-hepatectomy. Recent studies report significant correlation between chemotherapy (now frequently employed pre-hepatectomy for colorectal liver metastases (CRLM)), HS and steatohepatitis. Furthermore, raised body mass index (BMI) predisposes to HS. However, no previous study has analysed the effect of HS on long-term survival. Method: A retrospective analysis of a prospective consecutive cohort of 102 patients undergoing hepatectomy with 60 months follow-up data was performed. Resection specimens were examined histologically and the degree of steatosis graded accordingly. The data was compared to BMIs and other clinical characteristics. Statistical analyses included log-rank, contingency, logistic regression and Fisher''s exact tests. Results: No detectable fatty change in 27 patients; 1 patient had cirrhosis; 57 had HS: 26 graded mild; 10 moderate, 21 severe and 17 not graded. 1 patient (BMI 29.5kg/m2) had steatohepatitis but survived surgery. No significant difference in median survival between patients with and without HS (28.6 vs. 32.3 months, log-rank p >0.05). Results were similar between patients with BMI<25 and BMI≥25 (32.3 vs. 36.8 months, log-rank p >0.05). Analyses of BMI against steatosis grade showed that patients with a higher BMI were at an increased risk of having a more severe HS (logistic regression, p <0.01; Fisher''s exact, p <0.01). Contingency analyses on the influence of diabetes, chemotherapy and increasing number of risk factors on the likelihood of obtaining HS were insignificant (Fisher''s exact, all p >0.05). Conclusion: While patients with higher body mass index values are at increased risk of having more severe hepatic steatosis, neither BMI nor hepatic steatosis significantly influences long-term survival. We conclude therefore that neither obesity nor hepatic steatosis has significant prognostic relevance on long-term survival of CRLM patients undergoing hepatectomy. [Copyright &y& Elsevier]