Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer

Forrest, L M; McMillan, Donald C.; McArdle, C. S.; Angerson, Wilson J.; Dunlop, David J.

doi:10.1038/sj.bjc.6601242

Cited by 682 publications

(676 citation statements)

References 17 publications

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“…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.…”

Section: Discussionsupporting

confidence: 90%

“…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.…”

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confidence: 99%

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

Murri¹,

Bartlett²,

et al. 2006

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Prediction of outcome in patients with metastatic breast cancer remains problematical. The present study evaluated the value of an inflammation-based score (Glasgow Prognostic Score, GPS) in patients with metastatic breast cancer. The GPS was constructed as follows: patients with both an elevated C-reactive protein (410 mg l À1 ) and hypoalbuminaemia (o35 g l À1 ) were allocated a score of 2. Patients in whom only one or none of these biochemical abnormalities was present were allocated a score of 1 or 0, respectively. In total, 96 patients were studied. During follow-up 51 patients died of their cancer. On multivariate analysis of the GPS and treatment received, only the GPS (HR 2.26, 95% CI 1.45 -3.52, Po0.001) remained significantly associated with cancer-specific survival. The presence of a systemic inflammatory response (the GPS) appears to be a useful indicator of poor outcome independent of treatment in patients with metastatic breast cancer.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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

Murri¹,

Bartlett²,

et al. 2006

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“…An APPR has been well documented among patients with cancer, including gastric and oesophageal malignancies, and an elevated serum CRP has been identified as an adverse prognostic indicator, independent of stage of disease, among these patients (Rashid et al, 1982;Falconer et al, 1995;Kodama et al, 1999;McMillan et al, 2001McMillan et al, , 2003Nozoe et al, 2001;Forrest et al, 2003). The present study has confirmed these findings.…”

Section: Discussionsupporting

confidence: 85%

“…The presence of an APPR has been associated with weight loss, the presence of hypermetabolism and anorexia, extent of disease, the development of recurrence in advanced cancer, and adverse prognosis (independent of stage of disease) (Rashid et al, 1982;Kodama et al, 1999;McMillan et al, 2001McMillan et al, , 2003Nozoe et al, 2001;Forrest et al, 2003). In patients with gastric cancer, the presence of systemic inflammation has been associated with a markedly reduced median survival (9 vs 53 weeks, Po0.001) (Rashid et al, 1982).…”

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Elevated tumour interleukin-1β is associated with systemic inflammation: a marker of reduced survival in gastro-oesophageal cancer

et al. 2006

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Systemic inflammation is associated with adverse prognosis cancer but its aetiology remains unclear. We investigated the expression of proinflammatory cytokines within normal mucosa from healthy controls and tumour tissue in cancer patients and related these levels with markers of systemic inflammation and with the presence of a tumour inflammatory infiltrate. Tissue was collected from 56 patients with gastro-oesophageal cancer and from 12 healthy controls. Tissue cytokine mRNA concentrations were measured by real-time PCR and tissue protein concentrations by cytometric bead array. The degree of chronic inflammatory cell infiltrate was recorded. Serum cytokine and acute phase protein concentrations (including C-reactive protein (CRP)) were measured by enzymelinked immunosorbent assay. Proinflammatory cytokines were significantly overexpressed (interleukin (IL)-1b, IL-6, IL-8 and tumour necrosis factor-a) both at mRNA and protein levels in the cancer specimens compared with mucosa from controls. Interleukin-1b was expressed in greatest (10 -100-fold) concentration and protein levels correlated significantly with systemic inflammation (CRP) (P ¼ 0.05, r ¼ 0.31). A chronic inflammatory infiltrate was observed in 75% of the cancer specimens and was associated with systemic inflammation (CRP: P ¼ 0.01). However, the presence of chronic inflammation per se was not associated with altered cytokine expression within the tumour. Both a chronic inflammatory infiltrate and systemic inflammation (CRP) were associated with reduced survival (P ¼ 0.05 and P ¼ 0.03, respectively). Tumour chronic inflammatory infiltrate and tumour tissue IL-1b overexpression are potential independent factors influencing systemic inflammation in oesophagogastric cancer patients.

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“…Indeed, this relationship between nutritional decline, albumin concentrations and the systemic inflammatory response has recently been exploited to form a new prognostic score in patients with advanced non-small-cell lung cancer (Forrest et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

et al. 2004

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The relationship between hypoalbuminaemia, tumour volume and C-reactive protein was examined in patients with colorectal liver metastases (n ¼ 57). On multiple regression analysis, albumin concentrations were independently associated with C-reactive protein (r ¼ 0.56, Po0.001) but not percentage hepatic replacement (P ¼ 0.34). These results show that hypoalbuminaemia is associated with the presence of a systemic inflammatory response rather than tumour volume in patients with colorectal liver metastases. It has long been recognised that, in patients with advanced cancer, the presence of hypoalbuminaemia is associated with poor outcome (Franch-Arcas, 2001). In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour. Recently, however, it has been postulated that the reduction in albumin concentration is secondary to the presence of a systemic inflammatory response, as evidenced by elevated circulating concentrations of C-reactive protein (McMillan et al, 2001).The nature of the relationship between circulating albumin concentration, tumour burden and the systemic inflammatory response has not been established. However, if the presence of a systemic inflammatory response rather than tumour burden were to determine the development of the hypoalbuminaemia associated with advanced cancer, then it might be expected that there would be a stronger relationship between the presence of hypoalbuminaemia and the systemic inflammatory response compared with that between hypoalbuminaemia and tumour volume.The aim of the present study was to examine the relationship between circulating albumin concentration, the tumour burden and the systemic inflammatory response in patients with colorectal liver metastases. MATERIAL AND METHODS PatientsPatients who had undergone resection of a primary colorectal cancer, who then developed liver metastases and who were referred for assessment for liver resection, were considered eligible for study. As part of their assessment, patients underwent dual phase spiral-computed tomography of the liver. In addition a blood sample was taken for measurement of routine liver enzymes, albumin and C-reactive protein. Only those patients who had no evidence of extrahepatic disease were included in the study. None of the patients had recent chemotherapy.The study was approved by the Research Ethics Committee of Glasgow Royal Infirmary. Biochemical profileAlbumin, C-reactive protein, alkaline phosphatase, aspartate transaminase, alanine transaminase and bilirubin concentrations were assayed using standard methods. Intra-and inter-assay coefficients of variation were better than 5 and 10% respectively. Tumour volume and PHRTumour volume and percentage hepatic replacement (PHR) were measured using a similar approach to that previously described (Purkiss and Williams, 1992;Dworkin et al, 1995). Contrast enhanced CT-scans were performed using a Somatom plus 4 spiral-CT scanner (Siemens AG, Erlangen, Germany).The cross-sectional areas of all the metastat...

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Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer

Cited by 682 publications

References 17 publications

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

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

Elevated tumour interleukin-1β is associated with systemic inflammation: a marker of reduced survival in gastro-oesophageal cancer

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

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