The Glasgow prognostic score predicts survival in patients with advanced non-small cell lung cancer harboring sensitive EGFR mutations who are treated with tyrosine kinase inhibitors

Abstract

Background: Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with sensitive EGFR mutations. The Glasgow prognostic score (GPS) is an inflammation-assessing score based on C-reactive protein and albumin concentrations. Information regarding the association between the GPS and EGFR-TKI treatment effectiveness is limited; hence, we investigated whether the GPS can predict the response of NSCLC to EGFR-TKIs. Methods: We evaluated 340 patients with NSCLC harboring sensitive EGFRmutations who received EGFR-TKI monotherapy between March 2009 and July 2021. The Kaplan–Meier method and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). Results: After a median follow-up of 26.6 months, patients with a GPS of 0, 1, and 2 had PFS of 15.7, 10.0, and 6.3 months, respectively, and OS of 40.1, 25.8, and 14.4 months, respectively; patients with a GPS of 0 had significantly better PFS and OS than those with a GPS of 1 (P=0.03, P=0.001, respectively) or 2 (P<0.001, P<0.001, respectively). Multivariate analysis identified poor performance status, stage IV at diagnosis, type of EGFR-TKI (gefitinib/erlotinib vs. afatinib), and GPS=2 as predictors of a short PFS. Meanwhile, poor performance status, gefitinib/erlotinib administration, and GPS=2 were predictive of a short OS. Conclusions: The GPS predicted the survival of NSCLC patients harboring sensitive EGFRmutations who were undergoing EGFR-TKI treatment. The GPS might be ideal for routine use in clinical practice, given that it is an easily calculated parameter.