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The Glasgow Microenvironment Score associates with prognosis and adjuvant chemotherapy response in colorectal cancer

Alexander, Peter G., Roseweir, Antonia K., Pennel, Kathryn A. F., van Wyk, Hester C., Powell, Arfon G. M. T., McMillan, Donald C., Horgan, Paul G., Kelly, Caroline, Hay, Jennifer, Sansom, Owen, Harkin, Andrea, Roxburgh, Campbell S. D., Graham, Janet, Church, David N., Tomlinson, Ian, Saunders, Mark, Iveson, Tim J., Edwards, Joanne and Park, James H. 2021. The Glasgow Microenvironment Score associates with prognosis and adjuvant chemotherapy response in colorectal cancer. British Journal of Cancer 124 (4) , 786–796. 10.1038/s41416-020-01168-x

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Abstract

Background The Glasgow Microenvironment Score (GMS) combines peritumoural inflammation and tumour stroma percentage to assess interactions between tumour and microenvironment. This was previously demonstrated to associate with colorectal cancer (CRC) prognosis, and now requires validation and assessment of interactions with adjuvant therapy. Methods Two cohorts were utilised; 862 TNM I–III CRC validation cohort, and 2912 TNM II–III CRC adjuvant chemotherapy cohort (TransSCOT). Primary endpoints were disease-free survival (DFS) and relapse-free survival (RFS). Exploratory endpoint was adjuvant chemotherapy interaction. Results GMS independently associated with DFS (p = 0.001) and RFS (p < 0.001). GMS significantly stratified RFS for both low risk (GMS 0 v GMS 2: HR 3.24 95% CI 1.85–5.68, p < 0.001) and high-risk disease (GMS 0 v GMS 2: HR 2.18 95% CI 1.39–3.41, p = 0.001). In TransSCOT, chemotherapy type (pinteraction = 0.013), but not duration (p = 0.64) was dependent on GMS. Furthermore, GMS 0 significantly associated with improved DFS in patients receiving FOLFOX compared with CAPOX (HR 2.23 95% CI 1.19–4.16, p = 0.012). Conclusions This study validates the GMS as a prognostic tool for patients with stage I–III colorectal cancer, independent of TNM, with the ability to stratify both low- and high-risk disease. Furthermore, GMS 0 could be employed to identify a subset of patients that benefit from FOLFOX over CAPOX.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Springer Nature [academic journals on nature.com]
ISSN: 0007-0920
Date of First Compliant Deposit: 27 August 2021
Date of Acceptance: 28 October 2020
Last Modified: 07 Jan 2022 17:20
URI: https://orca.cardiff.ac.uk/id/eprint/143738

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