Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer

Abstract

There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients with advanced cancer. The aim of the present study was to examine whether an inflammation-based prognostic score (Glasgow Prognostic score, GPS) was associated with survival, in patients with inoperable gastro-oesophageal cancer. Patients diagnosed with inoperable gastro-oesophageal carcinoma and who had measurement of albumin and C-reactive protein concentrations, at the time of diagnosis, were studied (n ¼ 258). Clinical information was obtained from a gastro-oesophageal cancer database and analysis of the case notes. Patients with both an elevated C-reactive protein (410 mg l À1 ) and hypoalbuminaemia (o35 g l À1 ) were allocated a GPS score of 2. Patients in whom only one of these biochemical abnormalities was present were allocated a GPS score of 1, and patients with a normal C-reactive protein and albumin were allocated a score of 0. On multivariate survival analysis, age (hazard ratio (HR) 1.22, 95% CI 1.02 -1.46, Po0.05), stage (HR 1.55, 95% CI 1.30 -1.83, Po0.001), the GPS (HR 1.51, 95% CI 1.22 -1.86, Po0.001) and treatment (HR 2.53, 95% CI 1.80 -3.56, Po0.001) were significant independent predictors of cancer survival. A 12-month cancer-specific survival in patients with stage I/II disease receiving active treatment was 67 and 60% for a GPS of 0 and 1, respectively. For stage III/IV disease, 12 months cancer-specific survival was 57, 25 and 12% for a GPS of 0, 1 and 2, respectively. In the present study, the GPS predicted cancer-specific survival, independent of stage and treatment received, in patients with inoperable gastro-oesophageal cancer. Moreover, the GPS may be used in combination with conventional staging techniques to improve the prediction of survival in patients with inoperable gastro-oesophageal cancer.

Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

“…In our study, only five patients had a GPS of 2, with a poor outcome consistent with previous evidence (Crumley et al, 2006;Hwang et al, 2011).…”

Carcinoembryonic antigen and cytokeratin 20 in peritoneal cells of cancer patients: are we aware of what we are detecting by mRNA examination?

“…Nevertheless, prognosis for PCR-positive patients was shown to be significantly worse than for PCR-negative patients, and this was in accordance with the recent data of Crumley et al (2006) and Deans et al (2007), who linked inflammation symptoms with adverse prognosis in patients with gastric cancer. However, there are simpler and cheaper methods than qRT-PCR to assess inflammatory parameters.…”

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

“…Nevertheless, in Hwang's study, where 402 patients with advanced gastric adenocarcinoma were included, poor GPS depended largely on elevated CRP level other than descending albumin level (Hwang et al, 2011). In another study, Crumley et al (2006) indicated that low albumin was a confounding factor in the GPS scoring system. And Crumley also demonstrated that the development of hypo-albuminemia was secondary to an ongoing systemic inflammatory response and poor cancer specific survival was secondary to the systemic inflammatory response in patients with gastric cancer (Crumley et al, 2010).…”