Optimization of the systemic inflammation‐based Glasgow Prognostic Score

Abstract

BACKGROUND The modified Glasgow Prognostic Score (mGPS), an inflammation‐based prognostic score that uses thresholds of C‐reactive protein (> 10 mg/L) and albumin (< 35 g/L), has been found to be independently prognostic of survival in patients with cancer. The objective of the current study was to establish whether the addition of a differential leukocyte count and a high‐sensitivity C‐reactive protein measurement enhanced the prognostic value of the mGPS. METHODS A total of 12,119 patients who had an incidental blood sample taken between 2000 and 2007 for C‐reactive protein, albumin, and a differential leukocyte count as well as a diagnosis of cancer made within 2 years were identified. This group was studied for the prognostic value of neutrophil, lymphocyte, and platelet counts. In addition 2742 patients whose blood was sampled after the introduction of high‐sensitivity C‐reactive protein measurements were studied for the prognostic value of different thresholds. RESULTS Using cancer‐specific survival as an endpoint, the prognostic value of the mGPS (hazard ratio [HR], 2.61; P < .001 [area under the receiver operating characteristic curve (AUC), 0.695]) was found to be improved by the addition of neutrophil and platelet counts (HR, 4.86; P < .001 [AUC, 0.734]) and a high‐sensitivity C‐reactive protein measurement (> 3 mg/L) (HR, 5.77; P < .001 [AUC, 0.734]). CONCLUSIONS The results of the current study demonstrate that the addition of neutrophil and platelet counts, as well as a high‐sensitivity C‐reactive protein measurement, enhanced the prognostic value of the mGPS. Cancer 2013;119:2325–2332. © 2013 American Cancer Society.

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

“…CA19-9 level did not display a predictive value during second-line treatment, whereas it does have a predictive value for first-line treatment (11). Other biomarkers were not evaluated, including the Glasgow prognostic score or its modified version, which is an inflammation-based prognostic score using standard laboratory measurements of albumin and C-reactive protein (32,33). This score is able to identify systemic inflammatory responses responsible for poor survival due to tumor growth stimulation and catabolic effects on the host's metabolism at every stage of the disease for resectable, unresectable and metastatic pancreatic cancer (33)(34)(35).…”

“…Another limitation is the use of a monotherapy treatment. Various clinicians use a dual-therapy regimen such as gemcitabine and cisplatin or GemBrax subsequent to first-line folfirinox treatment, despite the lack of evidence regarding its efficacy from prospective studies (31)(32)(33). In France, reimbursement for nab-paclitaxel is not yet available, thus limiting its prescription.…”

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

“…The NLR and PLR reflect the populations of circulating white cells and platelets and have clinical advantages of being inexpensive and routinely measured in perioperative practice. They are, inferior to some other markers of a cancer-related systemic inflammatory response, such as serum CRP and albumin, the Glasgow prognostic score (GPS) or modified GPS (mGPS) (28,29), but serum CRP levels and other markers are not routinely performed as part of the preoperative assessment of patients. Hence, the NLR and PLR plus the absolute neutrophil, lymphocyte and platelet counts were assessed in patients with thymic carcinoma who were retrospectively evaluated in our study.…”

Quantitative data on the magnitude of the systemic inflammatory response and its relationship with serum measures of iron status

“…[18][19] Given that CRP and albumin also predict mortality from any cause, cancer, cardiovascular disease and cerebrovascular causes, it may be that the association of measures of iron status and mortality is dependent on the presence of systemic inflammation. 20 Further work is required to test this hypothesis.…”