Modified Glasgow Prognostic Score as a Predictor of Recurrence in Patients with High Grade Non-Muscle Invasive Bladder Cancer Undergoing Intravesical Bacillus Calmette–Guerin Immunotherapy

Abstract

Background: A systemic inflammatory marker, the modified Glasgow prognostic score (mGPS), could predict outcomes in non-muscle-invasive bladder cancer (NIMBC). We aimed to investigate the predictive power of mGPS in oncological outcomes in HG/G3 T1 NMIBC patients undergoing Bacillus Calmette–Guérin (BCG) therapy. Methods: We retrospectively reviewed patient’s medical data from multicenter institutions. A total of 1382 patients with HG/G3 T1 NMIBC have been administered adjuvant intravesical BCG therapy, every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months. The analysis of mGPS for recurrence and progression was performed using multivariable and univariable Cox regression models. Results: During follow-up, 659 patients (47.68%) suffered recurrence, 441 (31.91%) suffered progression, 156 (11.28%) died of all causes, and 67 (4.84%) died of bladder cancer. At multivariable analysis, neutrophil to lymphocyte ratio [hazard ratio (HR): 7.471; p = 0.0001] and erythrocyte sedimentation rate (ESR) (HR: 0.706; p = 0.006 were significantly associated with recurrence. mGPS has no statistical significance for progression (p = 0.076). Kaplan–Meier survival analysis showed a significant difference in survival among patients from different mGPS subgroups. Five-year OS was 93% (CI 95% 92–94), in patients with mGPS 0, 82.2% (CI 95% 78.9–85.5) in patients with mGPS 1 and 78.1% (CI 95% 60.4–70) in mGPS 2 patients. Five-year CSS was 98% (CI 95% 97–99) in patients with mGPS 0, 90% (CI 95% 87–94) in patients with mGPS 1, and 100% in mGPS 2 patients. Limitations are applicable to a retrospective study. Conclusions: mGPS may have the potential to predict recurrence in HG/G3 T1 NMIBC patients, but more prospective, with large cohorts, studies are needed to study the influence of systemic inflammatory markers in prediction of outcomes in NMIBC for a definitive conclusion.

Prognostic Utility of the Modified Glasgow Prognostic Score in Urothelial Carcinoma: Outcomes from a Pooled Analysis

“…According to the PRISMA guidelines, a flow chart of the literature selection process is shown in Figure 1 . After excluding unqualified studies, 13 studies including 12,524 patients were included in this pooled analysis [ 17 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…All included studies were retrospective analyses and were published from 2013 to 2022. Seven studies were on BC [ 17 , 22 , 23 , 24 , 30 , 31 , 33 ], four studies were on UTUC [ 25 , 26 , 27 , 28 ], and two studies were on both BC and UTUC [ 29 , 32 ]. Six studies were conducted in Asia (China, Japan, and Korea) [ 23 , 25 , 26 , 28 , 30 , 32 ], and seven studies were conducted in Western countries (the United States, Italy, the United Kingdom, and Austria) [ 17 , 22 , 24 , 27 , 29 , 31 , 33 ].…”

Predicting Recurrence of Non-Muscle-Invasive Bladder Cancer: Current Techniques and Future Trends

“…The population of this study was comprised of NMIBC patients in a very early phase, limiting the generalizability of the results. The study by Ferro et al [ 58 ] evaluated NLR, the erythrocyte sedimentation rate (ESR), and modified Glasgow prognostic score (mGPS) as predictors of recurrence. The mGPS scoring system is classified according to C-reactive protein (CRP) levels as follows: score 0 for patients with CRP <10 mg/L without high-serum albumin levels, score 1 for patients with CRP (>10 mg/L), and score 2 for CRP (>10 mg/L) with hypoalbuminemia (<3.5 g/dL).…”

“…Briefly, the 22 distinct clinical markers in Table 3 were studied with the aim of predicting bladder cancer recurrence. NLR was evaluated in four studies [ 55 , 56 , 57 , 58 ], one of which used an AI in the form of a DT algorithm, with accuracies ranging from 0.638 to 0.923. It was also found that the age may affect the accuracy of NLR [ 57 ], and age-correction may be necessary when using NLR as a predictor of recurrence.…”

“…It was also found that the age may affect the accuracy of NLR [ 57 ], and age-correction may be necessary when using NLR as a predictor of recurrence. The mGPS score and ESR [ 58 ], type of intervesical monotherapy [ 66 ], and gender [ 67 ] were found to correlate with an increased recurrence risk. Furthermore, a total of 12 urinary biomarkers were evaluated [ 59 , 60 , 61 ] with the combination of IL8, MMP9, MMP10, SERPINA1, VEGFA, ANG, CA9, APOE, SERPINE1, and SDC1 biomarkers [ 60 ] considered to be the best predictive model of the three studies.…”