Comparison of the prognostic value of ECOG-PS, mGPS and BMI/WL: Implications for a clinically important framework in the assessment and treatment of advanced cancer

Abstract

Background and Aims:The systemic inflammatory response is associated with the loss of lean tissue, anorexia, weakness, fatigue and reduced survival in patients with advanced cancer and therefore is important in the definition of cancer cachexia. The aim of the present study was to carry out a direct comparison of the prognostic value of Eastern Cooperative Oncology Group Performance Status (ECOG-PS), modified Glasgow Prognostic Score (mGPS) and Body Mass Index/Weight Loss Grade (BMI/WL grade) in patients with advanced cancer.Method: All data were collected prospectively across 18 sites in the UK and Ireland.Patient's age, sex, ECOG-PS, mGPS and BMI/WL grade were recorded, as were details of underlying disease including metastases. Survival data were analysed using univariate and multivariate Cox regression.Results: A total of 730 patients were assessed. The majority of patients were male (53%), over 65 years of age (56%), had an ECOG-PS>0/1 (56%), mGPS≥1 (56%), BMI≥25 (51%), <2.5% weight loss (57%) and had metastatic disease (86%). On multivariate cox regression analysis ECOG-PS (HR 1.61 95%CI 1.42-1.83, p<0.001), mGPS (HR 1.53, 95%CI 1.39-1.69, p<0.001) and BMI/WL grade (HR 1.41, 95%CI 1.25-1.60, p<0.001) remained independently associated with overall survival. In patients with a BMI/WL grade 0/1 both ECOG and mGPS remained independently associated with overall survival. Conclusion:The ECOG/mGPS framework may form the basis of risk stratification of survival in patients with advanced cancer.

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

“…In the present study, candidate criteria were directly compared in terms of their relationship with measures of body composition and physical function. ECOG-PS and mGPS were consistently associated with low skeletal muscle mass and function and therefore, together with our previous study [11], both ECOG-PS and mGPS would appear to pass the duck test as criteria to define cancer cachexia.…”

“…Therefore, BMI/WL grade appears to capture elements of the decline in fat mass. The present and previous [11] results clearly need to be repeated to prove the clinical utility of the ECOG-PS/mGPS framework. However, if this proves to be the case (and these observations are readily repeated) there are a number of important implications for the future diagnosis and treatment of cancer cachexia.…”

“…A biobank of data from patients with advanced cancer was analysed. All data were collected prospectively across 9 sites in the UK and Ireland (cancer centres, hospitals, and specialist palliative care units) over a five-year period (2011-2016) [9,11,12]. Eligible patients provided written informed consent, were adults, had advanced cancer including all cancer subtypes (defined as metastatic cancer with histological, cytological or radiological evidence, that was locally advanced, or receiving anti-cancer therapy with palliative intent) and had the ability to comply with study procedures including provision of a venous blood sample (taken on the day of consent).…”

“…Recently, these three criteria for the definition of cancer cachexia were directly compared and all three independently predicted survival in patients with advanced cancer [11]. However, BMI/WL grade was low risk in approximately 50% of patients and ECOG-PS and mGPS were independently associated with survival in this group.…”

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

“…The values of them were divided into high and low; Eastern Cooperative Oncology Group performance status ( E C O G -P S ) ( < 2 , ≥ 2 ) , A m e r i c a n S o c i e t y o f Anesthesiologists physical status (ASA-PS) (< 3, ≥ 3), Charlson comorbidity index (CCI) (< 2, ≥ 2), PNI (< 45, ≥ 45), modified GPS (mGPS) (< 1, ≥ 1), CAR, neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and psoas muscle mass index (PMI, cm 2 /m 2 ) for evaluating sarcopenia. The cut-offs of the former 5 indices were based on previous reports (Onodera et al 1984;Toiyama et al 2011;Zhang et al 2015;Dolan et al 2019;Nakajo et al 2019;Tanoue et al 2019). Since CAR, NLR, and PLR have no definite cut-offs for predicting OS, the cut-offs of them were determined using receiver-operating characteristic (ROC) curve analysis; the values that maximized the sum of sensitivity and specificity for OS were used as the cut-offs.…”