Modified Glasgow Prognostic Score associated with survival in metastatic renal cell carcinoma treated with immune checkpoint inhibitors

Abstract

BackgroundThe modified Glasgow Prognostic Score (mGPS) is a composite biomarker that uses albumin and C reactive protein (CRP). There are multiple immune checkpoint inhibitor (ICI)-based combinations approved for metastatic renal cell carcinoma (mRCC). We investigated the ability of mGPS to predict outcomes in patients with mRCC receiving ICI.MethodsWe retrospectively reviewed patients with mRCC treated with ICI as monotherapy or in combination at Winship Cancer Institute between 2015 and 2020. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of ICI until death or clinical/radiographical progression, respectively. The baseline mGPS was defined as a summary score based on pre-ICI values with one point given for CRP>10 mg/L and/or albumin<3.5 g/dL, resulting in possible scores of 0, 1 and 2. If only albumin was low with a normal CRP, no points were awarded. Univariate analysis (UVA) and multivariate analysis (MVA) were carried out using Cox proportional hazard model. Outcomes were also assessed by Kaplan-Meier analysis.Results156 patients were included with a median follow-up 24.2 months. The median age was 64 years and 78% had clear cell histology. Baseline mGPS was 0 in 36%, 1 in 40% and 2 in 24% of patients. In UVA, a baseline mGPS of 2 was associated with shorter OS (HR 4.29, 95% CI 2.24 to 8.24, p<0.001) and PFS (HR 1.90, 95% CI 1.20 to 3.01, p=0.006) relative to a score of 0; this disparity in outcome based on baseline mGPS persisted in MVA. The respective median OS of patients with baseline mGPS of 0, 1 and 2 was 44.5 (95% CI 27.3 to not evaluable), 15.3 (95% CI 11.0 to 24.2) and 10 (95% CI 4.6 to 17.5) months (p<0.0001). The median PFS of these three cohorts was 6.7 (95% CI 3.6 to 13.1), 4.2 (95% CI 2.9 to 6.2) and 2.6 (95% CI 2.0 to 5.6), respectively (p=0.0216). The discrimination power of baseline mGPS to predict survival outcomes was comparable to the IMDC risk score based on Uno’s c-statistic (OS: 0.6312 vs 0.6102, PFS: 0.5752 vs 0.5533).ConclusionThe mGPS is prognostic in this cohort of patients with mRCC treated with ICI as monotherapy or in combination. These results warrant external and prospective validation.

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

“…Most candidate biomarkers involve tumor molecular characteristics and are subject to several limitations, including the one-dimensional nature, need for biopsy, and cost issues [ 34 , 35 ]. The compound prognostic scores based on simple clinical and laboratory parameters have recently gained significant interest for prognosis prediction in ICI-treated patients [ 36 , 37 ]. 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 Modified Glasgow Prognostic Score Predicts Survival in Gastric Cancer Patients with Normal CEA and CA19-9

“…Emerging evidence indicates that angiogenesis and immunosuppression frequently occur simultaneously during tumor growth and evolution through constant crosstalk with the surrounding microenvironment [ 31 ]. Recent study suggests that mGPS may serve as a biomarker to reflect sensitivity to immune checkpoint inhibitors in advanced GC and renal cancer [ 30 , 32 ]. However, no other study has explored whether mGPS can be used for predicting postoperative survival in GC patients with normal CEA and CA19-9.…”

Hypoalbuminemia predicts inferior outcome in patients with AIDS-related lymphoma

“…Malnutrition is common in HIV infection and plays an independent and significant role in its morbidity and mortality [ 19 , 20 ]. Low serum albumin at diagnosis has been identified as a simple prognostic factor in some cancers including non-Hodgkin's lymphoma (NHL) [ 21 – 25 ] which comprises more than 50% of all AIDS-defining cancers. However, its role in predicting clinical outcomes of AIDS-related lymphoma has not been evaluated.…”