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The modified Glasgow Prognostic Score indicates an increased risk of anastomotic leakage after anterior resection for rectal cancer

Golshani, Parisa ; Park, Jennifer ; Häggström, Jenny ; Segelman, Josefin ; Matthiessen, Peter ; Lydrup, Marie Louise LU and Rutegård, Martin (2023) In International Journal of Colorectal Disease 38(1).
Abstract

Background: Preoperative inflammation might cause and also be a marker for anastomotic leakage after anterior resection for rectal cancer. Available biomarker indices such as the modified Glasgow Prognostic Score (mGPS) or the C-reactive protein-to-albumin ratio (CAR) may be clinically useful for leakage assessment. Methods: Patients who underwent anterior resection for rectal cancer during 2014–2018 from a multicentre retrospective cohort were included. Data from the Swedish Colorectal Cancer registry and chart review at each hospital were collected. In a subset of patients, preoperative laboratory assessments were available, constituting the exposures mGPS and CAR. Anastomotic leakage within 12 months was the outcome. Causally... (More)

Background: Preoperative inflammation might cause and also be a marker for anastomotic leakage after anterior resection for rectal cancer. Available biomarker indices such as the modified Glasgow Prognostic Score (mGPS) or the C-reactive protein-to-albumin ratio (CAR) may be clinically useful for leakage assessment. Methods: Patients who underwent anterior resection for rectal cancer during 2014–2018 from a multicentre retrospective cohort were included. Data from the Swedish Colorectal Cancer registry and chart review at each hospital were collected. In a subset of patients, preoperative laboratory assessments were available, constituting the exposures mGPS and CAR. Anastomotic leakage within 12 months was the outcome. Causally oriented analyses were conducted with adjustment for confounding, as well as predictive models. Results: A total of 418 patients were eligible for analysis. Most patients had mGPS = 0 (84.7%), while mGPS = 1 (10.8%) and mGPS = 2 (4.5%) were less common. mGPS = 2 (OR: 4.11; 95% CI: 1.69–10.03) seemed to confer anastomotic leakage, while this was not seen for mGPS = 1 (OR 1.09; 95% CI: 0.53–2.25). A cut off point of CAR > 0.36 might be indicative of leakage (OR 2.25; 95% CI: 1.21–4.19). Predictive modelling using mGPS rendered an area-under-the-curve of 0.73 (95% CI: 0.67–0.79) at most. Discussion: Preoperative inflammation seems to be involved in the development of anastomotic leakage after anterior resection for cancer. Inclusion into prediction models did not result in accurate leakage prediction, but high degrees of systemic inflammation might still be important in clinical decision-making.

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anastomotic leak, Colorectal, Inflammation
in
International Journal of Colorectal Disease
volume
38
issue
1
article number
200
publisher
Springer
external identifiers
  • pmid:37470911
  • scopus:85165355267
ISSN
0179-1958
DOI
10.1007/s00384-023-04496-5
language
English
LU publication?
yes
id
f47ca93f-4755-4469-a773-d80305ec356f
date added to LUP
2023-08-28 13:47:51
date last changed
2024-04-20 02:04:37
@article{f47ca93f-4755-4469-a773-d80305ec356f,
  abstract     = {{<p>Background: Preoperative inflammation might cause and also be a marker for anastomotic leakage after anterior resection for rectal cancer. Available biomarker indices such as the modified Glasgow Prognostic Score (mGPS) or the C-reactive protein-to-albumin ratio (CAR) may be clinically useful for leakage assessment. Methods: Patients who underwent anterior resection for rectal cancer during 2014–2018 from a multicentre retrospective cohort were included. Data from the Swedish Colorectal Cancer registry and chart review at each hospital were collected. In a subset of patients, preoperative laboratory assessments were available, constituting the exposures mGPS and CAR. Anastomotic leakage within 12 months was the outcome. Causally oriented analyses were conducted with adjustment for confounding, as well as predictive models. Results: A total of 418 patients were eligible for analysis. Most patients had mGPS = 0 (84.7%), while mGPS = 1 (10.8%) and mGPS = 2 (4.5%) were less common. mGPS = 2 (OR: 4.11; 95% CI: 1.69–10.03) seemed to confer anastomotic leakage, while this was not seen for mGPS = 1 (OR 1.09; 95% CI: 0.53–2.25). A cut off point of CAR &gt; 0.36 might be indicative of leakage (OR 2.25; 95% CI: 1.21–4.19). Predictive modelling using mGPS rendered an area-under-the-curve of 0.73 (95% CI: 0.67–0.79) at most. Discussion: Preoperative inflammation seems to be involved in the development of anastomotic leakage after anterior resection for cancer. Inclusion into prediction models did not result in accurate leakage prediction, but high degrees of systemic inflammation might still be important in clinical decision-making.</p>}},
  author       = {{Golshani, Parisa and Park, Jennifer and Häggström, Jenny and Segelman, Josefin and Matthiessen, Peter and Lydrup, Marie Louise and Rutegård, Martin}},
  issn         = {{0179-1958}},
  keywords     = {{Anastomotic leak; Colorectal; Inflammation}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer}},
  series       = {{International Journal of Colorectal Disease}},
  title        = {{The modified Glasgow Prognostic Score indicates an increased risk of anastomotic leakage after anterior resection for rectal cancer}},
  url          = {{http://dx.doi.org/10.1007/s00384-023-04496-5}},
  doi          = {{10.1007/s00384-023-04496-5}},
  volume       = {{38}},
  year         = {{2023}},
}