An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study

Abstract

Introduction:A selective combination of C-reactive protein and albumin (termed the modified Glasgow Prognostic Score, mGPS) has been shown to have prognostic value, independent of tumour stage, in lung, gastrointestinal and renal cancers. It is also of interest that liver function tests such as bilirubin, alkaline phosphatase and γ-glutamyl transferase, as well as serum calcium, have also been reported to predict cancer survival. The aim of the present study was to examine the relationship between an inflammation-based prognostic score (mGPS), biochemical parameters, tumour site and survival in a large cohort of patients with cancer.Methods:Patients (n=21 669) who had an incidental blood sample taken between 2000 and 2006 for C-reactive protein, albumin and calcium (and liver function tests where available) and a diagnosis of cancer were identified. Of this group 9608 patients who had an ongoing malignant process were studied (sampled within 2 years before diagnosis). Also a subgroup of 5397 sampled at the time of diagnosis (sampled within 2 months prior to diagnosis) were examined. Cancers were grouped by tumour site in accordance with International Classification of Diseases 10 (ICD 10).Results:On follow up, there were 6005 (63%) deaths of which 5122 (53%) were cancer deaths. The median time from blood sampling to diagnosis was 1.4 months. Increasing age, male gender and increasing deprivation was associated with a reduced 5-year overall and cancer-specific survival (all P<0.001). An elevated mGPS, adjusted calcium, bilirubin, alkaline phosphatase, aspartate transaminase, alanine transaminase and γ-glutamyl transferase were associated with a reduced 5-year overall and cancer-specific survival (independent of age, sex and deprivation in all patients sampled), as well as within the time of diagnosis subgroup (all P<0.001). An increasing mGPS was predictive of a reduced cancer-specific survival in all cancers (all P<0.001).Conclusion:The results of the present study indicate that the mGPS is a powerful prognostic factor when compared with other biochemical parameters and independent of tumour site in patients with cancer.

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

“…GPS is a combination of serum CRP and albumin concentrations (Forrest et al, 2003), which appears to reflect the systemic inflammatory response as well as nutritional status (Kao et al, 2010;Proctor et al, 2011). Nevertheless, in Hwang's study, where 402 patients with advanced gastric adenocarcinoma were included, poor GPS depended largely on elevated CRP level other than descending albumin level (Hwang et al, 2011).…”

Systemic inflammation and survival of patients with prostate cancer: evidence from the Glasgow Inflammation Outcome Study

“…The mGPS and NLR were constructed as described in previous studies 16,17,19 (Table 1). Follow-up was from date of incidence of cancer to the date of death or censor date (31 December 2008), whichever came first.…”

Pre-treatment neutrophil to lymphocyte ratio as a predictive marker for pathological response to preoperative chemoradiotherapy in pancreatic cancer

“…The evaluation of predictive factors for the pathological response among clinical information were assessed, including a number of prognostic markers that have been previously reported: NLR (23), PLR (24), mGPS (21) and PNI (22). Upon univariate analysis, NLR and mGPS were determined to be significantly associated with the pathological response, whilst the other prognostic markers were not (Table IIIA).…”