Clinical utility of the Glasgow Prognostic Score in patients undergoing curative nephrectomy for renal clear cell cancer: basis of new prognostic scoring systems

Abstract

Background:Measurement of the systemic inflammatory response in malignancy has been recently refined using a selective combination of C-reactive protein and albumin (modified Glasgow Prognostic Score, mGPS). This has prognostic value in patients with metastatic kidney cancer. This study examines the prognostic value of the mGPS in patients undergoing curative nephrectomy for clear cell cancer.Methods:Patients with localised renal cell carcinoma undergoing potentially curative resection between March 1997 and July 2007 in a single institution were prospectively studied. The mGPS, University of California Los Angeles Integrated Staging System (UISS), ‘Stage Size Grade Necrosis' (SSIGN), Kattan and Leibovich scores were constructed.Results:A total of 169 patients were studied. The minimum follow-up was 49 months; the median follow-up of the survivors was 98 months. During this period, 35 patients died of their cancer; a further 24 patients died of intercurrent disease. On univariate survival analysis of the scoring systems, Kattan (P<0.05), UISS (P<0.001), SSIGN (P<0.001) and Leibovich (P<0.001) were significantly associated with cancer-specific survival. Using cancer-specific mortality at 4 years as an endpoint, the area under the receiver operator curve was 0.726 (95% CI 0.629–0.822; P=0.001) for Kattan, 0.776 (95% CI 0.671–0.880; P<0.001) for UISS, 0.812 (95% CI 0.733–0.892; P<0.001) for SSIGN, 0.778 (95% CI 0.666–0.889; P<0.001) for Leibovich and 0.800 (95% CI 0.687–0.912; P<0.001) for the mGPS scoring system. On multivariate analysis of significant independent scoring systems and mGPS, UISS (HR 3.08, 95% CI 1.54–6.19, P=0.002) and mGPS (HR 5.13, 95% CI 2.89–9.11, P<0.001) were significant independent predictors of cancer-specific survival.Conclusions:The present prospective study shows that the mGPS, an inflammation-based prognostic score, is at least equivalent to and independent of other current validated prognostic scoring systems for patients undergoing curative nephrectomy for renal clear cell cancer. The mGPS is simple, measured preoperatively, based on well-standardised, widely available protein assays, and therefore provides an objective and rational basis before treatment for future staging systems in patients with operable renal cancer.

Utility of Inflammation-based Prognostic Scoring in Patients Given Systemic Chemotherapy First-line for Advanced Inoperable Bladder Cancer

“…Advanced bladder cancer and prognostic score status as an independent correlate of CSS in metastatic and localized (operable) renal cell carcinoma (26,27). Although the specifics of our study differed, GPS still emerged as a significant independent prognosticator of OS, in line with prior findings.…”

Prognostic value of inflammation-based scores in patients with osteosarcoma

“…It was first introduced by Forrest et al ., who evaluated its prognostic significance in inoperable non-small-cell lung cancer27. After that, GPS was found to be a prognostic factor in various other tumors, such as renal clear cell cancer, gastric cancer, gallbladder cancer, and Esophageal squamous cell carcinoma15282930. Patients with GPS more than zero have elevated CRP or hypoalbuminaemia or even both of them, implying GPS presents not only inflammation status but also nutritional status of cancer patients.…”

Glasgow prognostic score predicts therapeutic outcome after hepatic resection for hepatocellular carcinoma

“…An inflammatory response to the tumor leads to tumor proliferation and metastasis due to inhibition of apoptosis and promotion of angiogenesis (27)(28)(29)(30). The GPS is a clinically useful inflammation-based prognostic scoring system for predicting the postoperative prognosis of the patients with colorectal cancer (9), esophageal cancer (10), bladder cancer (11), pancreatic head cancer (12), renal clear cell cancer (13), non-small cell lung cancer (14), and HCC (18,19). The GPS is evaluated using only serum CRP and serum albumin, which are common laboratory parameters for assessment of preand postoperative patients status.…”

“…Several recent investigators reported that the systemic inflammatory response by the combination of serum C-reactive protein (CRP) and albumin concentrations, i.e., Glasgow prognostic score (GPS), predicts cancer-specific survival (9)(10)(11)(12)(13)(14). We previously reported the GPS as a predictor of long-term therapeutic outcome for hepatobiliary malignancies, including carcinoma of the ampulla of Vater (15), gallbladder cancer (16), and unresectable colorectal cancer liver metastasis (17).…”