C-reactive protein/albumin ratio and modified Glasgow prognostic score are associated with prognosis and infiltration of Foxp3+ or CD3+ lymphocytes in colorectal liver metastasis

Background: Inflammatory indices and tumor-infiltrating lymphocytes (TILs) have prognostic value in many cancers. This study aimed to assess the prognostic value of inflammatory indices and evaluate their correlation with survival and the presence of TILs in colorectal liver metastasis (CRLM). Methods: Medical records of 117 patients who underwent hepatectomy for CRLM were retrospectively reviewed. We calculated inflammatory indices such as neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein/albumin ratio (CAR), and modified Glasgow prognostic score (mGPS) and evaluated their relationship with survival rates and immunohistochemical results of tumor-infiltrating CD3+, CD8+, and Foxp3+ lymphocytes. Results: : Patients with low CAR values and low mGPS had significantly better overall survival in the log-rank test (p=0.0246 and p=0.0121, respectively). In multivariate analysis using the Cox proportional hazard model, CAR (hazard ratio [HR], 0.5717; 95% confidence interval [CI], 0.3288–0.9939; p=0.0475) and mGPS (HR, 0.4000; 95% CI, 0.1934–0.8270; p=0.0134) were independent prognostic factors. Additionally, Foxp3+ lymphocytes were more common in samples of patients with low CAR (p=0.0409), and the number of CD3+ TILs was significantly higher in patients with low mGPS (p=0.0152). Conclusions: : CAR and mGPS are simple, inexpensive, and objective markers associated with survival of patients with CRLM. Moreover, they can predict the presence of Foxp3+ and CD3+ lymphocytes in the invasive margin of the tumor.