Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer

Abstract

The value of an inflammation-based prognostic score (GPS) was compared with performance status (ECOG) in patients (n ¼ 109) receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. On multivariate analysis with ECOG, white cell count and the GPS entered as covariates, only the GPS was a significant independent predictor of survival (HR 1.88, 95% CI 1.25 -2.84, P ¼ 0.002). Non-small-cell lung cancer (NSCLC) is the most common cause of cancer death in North America and Western Europe. Most patients present with advanced inoperable disease; the prognosis of these patients is extremely poor. In selected patients, platinum-based regimens have been shown to have a beneficial but modest impact on survival (Klastersky and Paesmans, 2001). Conventionally, the selection of patients for chemotherapy has been based on clinicopathological criteria, including age, stage and performance status (Numico et al, 2001).There is increasing evidence that the presence of a systemic inflammatory response, as evidenced by elevated circulating concentrations of C-reactive protein concentrations, is associated with early recurrence and poor survival, independent of stage, in a variety of common solid tumours (Ikeda et al, 2003;McMillan et al, 2003). In advanced disease, an elevated C-reactive protein has also been shown to associated with poor survival (O'Gorman et al, 2000;Mahmoud and Rivera, 2002).Furthermore, in an unselected cohort of patients with inoperable NSCLC, the Glasgow Prognostic Score (GPS), a cumulative prognostic score based on C-reactive protein and albumin, had similar prognostic value to that of stage and performance status (Forrest et al, 2003). The question of whether the GPS would be useful in the selection of appropriate treatment for patients with inoperable NSCLC remains to be determined.The aim of the present study was to assess the value of the GPS in patients receiving chemotherapy for inoperable NSCLC. MATERIALS AND METHODS Study designPatients presenting with inoperable NSCLC (stages III and IV) to a single multidisciplinary oncology clinic in Glasgow Royal Infirmary between March 2000 and June 2003 were studied prospectively. All patients had cytologically or histologically confirmed disease and were staged on the basis of clinical findings, chest X-ray and, where appropriate, bronchoscopy, liver ultrasound, isotope bone scan and computerised tomography of the thorax, according to the American Thoracic Society TNM classification (Mountain, 1991).Clinical stage, tumour type and performance status (Eastern Cooperative Oncology Group, ECOG) were recorded at the time of diagnosis. A blood sample was also obtained for the measurement of white cell count, albumin and C-reactive protein concentrations. Patients received between one and six cycles of platinum-based chemotherapy.The study was approved by the Research Ethics Committee of Glasgow Royal Infirmary. MethodsBlood parameters: Routine laboratory measurements of albumin and C-reactive protein concentration were carried out. The coeffic...

Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer

“…This work is consistent with previous work in patients with inoperable nonsmall-cell lung cancer (Forrest et al, 2003(Forrest et al, , 2004(Forrest et al, , 2005 and improves on the prediction of survival using an elevated C-reactive protein alone (Albuquerque et al, 1995;Zhang and Adachi, 1999). If these results are confirmed in larger studies, the GPS may be useful in the assessment of advanced breast cancer patients at diagnosis and the stratification of patients entering randomised trials.…”

“…It has been previously shown that, in patients with inoperable non-small-cell lung cancer at diagnosis, approximately threequarters of patients had an abnormal GPS (1 or 2) and that these patients had a significantly poorer outcome (Forrest et al, 2003(Forrest et al, , 2004. It was of interest that, in the present study, although the proportion of patients with an abnormal GPS was less (47%), those metastatic breast cancer patients with a GPS of 2 had a similarly poorer survival.…”

“…However, almost all the patients received active treatment and this would suggest that they had similar good performance status. Moreover, performance status is subjective (Ando et al, 2001) and the GPS has been shown to be a prognostic factor, independent of performance status in patients with inoperable non-small-cell lung cancer (Forrest et al, 2003(Forrest et al, , 2004. Other recognised prognostic factors, which have been shown to affect survival post relapse, such as ER status and disease free interval, did not reach statistical significance.…”

“…Recently, we have shown that, using established cutoffs, a combination of an elevated C-reactive protein and hypoalbuminaemia, the Glasgow Prognostic score (GPS) has prognostic value, independent of stage and performance status, in patients with inoperable non-small-cell lung cancer (Forrest et al, 2003(Forrest et al, , 2004(Forrest et al, , 2005. However, there is no information on the prognostic value of this combination in patients with metastatic breast cancer.…”

Preoperative globulin‐to‐albumin ratio predicts outcome after curative resection in patients with gastric cancer

“…We calculated each patient's GPS as follows: Patient with elevated level of CRP (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) was assigned a score of 2, patient who exhibited one of these abnormalities was assigned a score of 1, and patient with no abnormalities was assigned a score of 0 8. The NLR was calculated as the patient's neutrophil level (% or number of neutrophils) divided by the lymphocyte level (% or number of lymphocytes) 9.…”