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Systemic Inflammation – Impact on Tumor Biology and Outcomes in Colorectal Cancer

Michael Lam, Jeanne Tie, Belinda Lee, Jayesh Desai, Peter Gibbs and Ben Tran

Inflammation is increasingly recognized as a major factor in cancer development and progression. While local inflammation, represented by higher density of tumor infiltrating immune cells, is associated with better outcomes, the presence of systemic inflammation is conversely associated with poorer outcomes. This has been studied extensively in colorectal cancer where surrogates of systemic inflammation, such as serum albumin, C-reactive peptide, neutrophils and lymphocytes, have been shown to have prognostic significance independent of traditional clinicopathological factors. Despite the strength of this clinical data, the biological mechanisms underlying the poor outcomes are not well understood. This review details the impact of systemic inflammation on outcomes in colorectal cancer and examines what is known about the underlying biology.