Prognostic Factors in Patients with Advanced Cancer: A Comparison of Clinicopathological Factors and the Development of an Inflammation-Based Prognostic System

Abstract

Purpose: In advanced cancer, oncological treatment is influenced by performance status (PS); however, this has limitations. Biomarkers of systemic inflammation may have prognostic value in advanced cancer. The study compares key factors in prognosis (performance status, patient-reported outcomes; PRO) with an inflammation-based score (Glasgow Prognostic Score, mGPS). A new method of prognosis in advanced cancer (combining performance status and mGPS) is tested and then validated.Experimental Design: Two international biobanks of patients with advanced cancer were analyzed. Key prognostic factors [performance status, PROs (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30), and mGPS (using C-reactive protein and albumin concentrations)] were examined. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods, in a test sample before independent validation.Results: Data were available on 1,825 patients (test) and 631 patients (validation). Median survival ranged from 3.2 months (test) to 7.03 months (validation). On multivariate analysis, performance status (HR 1.62-2.77) and mGPS (HR 1.51-2.27) were independently associated with, and were the strongest predictors of survival (P < 0.01). Survival at 3 months varied from 82% (mGPS 0) to 39% (mGPS 2) and from 75% (performance status 0-1) to 14% (performance status 4). When used together, survival ranged from 88% (mGPS 0, PS 0-1) to 10% (mGPS 2, performance status 4), P < 0.001.Conclusion: A systemic inflammation-based score, mGPS, and performance status predict survival in advanced cancer. The mGPS is similar to performance status in terms of prognostic power. Used together, performance status and mGPS act synergistically improving prognostic accuracy. This new method may be of considerable value in the management of patients with advanced cancer.

Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

“…high or low), compared to the more subjective nature of assessment of a patient's physical activity and performance status. [20] However, in keeping with previous work, [18] the combination of both measures provided complimentary prognostic information, particularly when further stratified by M stage; indeed, it was possible to identify patients with oesophageal cancer and a relatively good prognosis with expected survival rate at three months of 83% and who may benefit from consideration of other modalities rather than SEMS insertion. [1,9] Conversely, it was also possible to identify patients with a dismal prognosis and three-months survival of around 8%; this groups would be more likely benefit from immediate palliation by SEMS insertion as well as accelerated referral to palliative care services.…”

“…[15,16] One such score, the modified Glasgow Prognostic Score (mGPS), is based on the combination of serum C-reactive protein (CRP) and albumin concentrations and has been shown to hold prognostic value not only across several solid organ cancers, but also across patients undergoing treatment with both curative and palliative intent. [17,18] As such, the systemic inflammatory response, and the mGPS appears a rational and easily measurable characteristic on which to base a prognostic scoring system for patients with advanced OG cancer. Therefore, the aim of the present study was to examine the prognostic value of the mGPS in addition to other host and tumour characteristics in patients undergoing palliative SEMS insertion for OG cancer.…”

A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer

“…However, the absence of signs of gross clinical oedema (increasing ankle swelling, ascites, and pleural effusions) provides some supporting favourable evidence that weight gain was not entirely due to expansion of the extracellular water space. Of note was that plasma C‐reactive protein levels were higher in the treatment arm, and as higher C‐reactive protein concentrations have been related to adverse survival, this may have counterbalanced any survival advantages conferred by the intervention 37. Clearly the sample size was not designed to assess such aspects however this would be of interest in future studies.…”

Is There a Sex Effect in Colon Cancer? Disease Characteristics, Management, and Outcomes in Routine Clinical Practice

“…Disease progression in cancer patients is known to be influenced by the host inflammatory response and the immune system 22 , with an elevated systemic inflammatory response being associated with worse outcome independent of tumour stage 23,24 . It has been proposed that female sex hormones might exert a protective immunologic effect on the inflammatory response.…”