Gustave Roussy Immune Score as a Novel Prognostic Scoring System for Colorectal Cancer Patients: A Propensity Score Matching Analysis

Abstract

AimThe Gustave Roussy Immune Score (GRIm-Score) was originally designed to select cancer patients for immunotherapy, and later was reported to be a novel prognostic scoring system in lung cancer and esophageal cancer. This study was aimed to determine the prognostic role and predictive performance of GRIm-Score in colorectal cancer (CRC) CRC patients.MethodsWe conducted a single-institution study of 1,579 adult CRC patients receiving surgical removal, and those patients were divided into low GRIm-Score group (scores 0, 1) and high GRIm-Score group (scores 2, 3). Propensity score matching (PSM) was executed to balance the potential confounding factors between the two groups. Survival and time-dependent receiver operating characteristic (Td-ROC) analyses were applied to depict the prognostic role and predictive significance of GRIm-Score in CRC patients.ResultsThere were 200 cases CRC patients in high GRIm-Score group and 1,379 cases in low GRIm-Score group. CRC patients with high GRIm-Score correspond with higher level of CEA, CA125, and inflammatory indexes, such as NLR, PLR, SII, PNI, and ALRI. Correlation analysis exhibited that GRIm-Score correlated well with the established inflammatory indexes. Survival analysis revealed that CRC patients in high GRIm-Score group showed worse overall survival (OS, P <0.0001) and disease-free survival (DFS, P <0.0001) compared with those in low GRIm-Score group. Results from multivariate Cox regression implicated that high GRIm-Score was not only a potent prognostic index for unfavorable OS (HR = 1.622, 95%CI: 1.118–2.355, P = 0.0109), but also a potent risk factor for worse DFS (HR = 1.743, 95%CI: 1.188–2.558, P = 0.0045). Td-ROC analysis demonstrated that GRIm-Score exhibited the superior discriminatory power in the prediction of OS and DFS when compared to SII, PNI, and ALRI. Such strong associations between high levels of preoperative GRIm-Score and unfavorable survival outcomes remained robust after PSM analysis.ConclusionGRIm-Score, a novel inflammatory and nutritional risk scoring system, is a potent prognostic index in CRC patients receiving surgical removal. GRIm-Score can be used as an effective and simplified risk stratification tool for postoperative survival prediction of CRC patients.

The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy

“…Similar to our study, most of these scores were developed in the basket immunotherapy cohorts and incorporated complete blood count and biochemistry parameters into the scoring systems; however, dynamic changes in the laboratory parameters are absent in these scores [ 30 , 32 , 38 , 39 ]. The most thoroughly investigated of these scores are the GRS and RMH scores [ 31 , 40 , 41 ]. Both scores include the baseline LDH (normal vs. ≥ULN) and albumin levels (3.5 g/dL vs. <3.5 g/dL), while the baseline NLR levels and number of metastatic sites were used in the GRS [ 30 ] and RMH scores [ 31 ], respectively.…”

Gustave Roussy Immune Score for Predicting Postoperative Complications and Non-cancer Death in Elderly Patients With Colon Cancer

“…The three components of the score (NLR, LDH, and albumin) re ect patients' nutritional status, systemic in ammation, and immune status [13]. Previous studies have reported that GRIm score correlated with tumor stage, tumor size, BMI, and performance status [15,16,20]. In the present study, GRIm score was closely correlated with patient characteristics and tumor conditions, including advanced age, comorbidities, and T/N/M status, in agreement with the previous reports.…”

“…GRIm score has reported as a prognostic factor for various cancers [14][15][16]. Feng and colleagues examined the prognostic value of GRIm score in esophageal cancer [14], and found that patients with high GRIm had poor CSS compared to those with low GRIm (10.3% vs. 35.0%, p < 0.001).…”

“…Feng and colleagues examined the prognostic value of GRIm score in esophageal cancer [14], and found that patients with high GRIm had poor CSS compared to those with low GRIm (10.3% vs. 35.0%, p < 0.001). In the survival analysis of Tian and colleagues regarding the prognostic role and predictive performance of GRIm score for adult patients with colorectal cancer [15] patients with a high GRIm score had poor disease-free survival (DFS) (p < 0.0001) and poor OS (p < 0.0001). Multivariate analysis also indicated that high GRIm score was a potent predictive factor for poor DFS (HR, 1.743; 95%CI, 1.188-2.558; p = 0.0045) and poor OS (HR, 1.622; 95%CI, 1.118-2.355; p = 0.0109).…”

“…GRIm score comprises neutrophil to lymphocyte ratio (NLR), serum albumin, and lactate dehydrogenase (LDH). Some previous studies have reported a correlation between GRIm score and prognosis [14][15][16], and levels of the individual GRIm score components (NLR [17,18], serum albumin [9], and LDH [19]) have also been related to POCs and mortality.…”