Prediction of Postoperative Clinical Outcomes in Resected Stage I Non-Small Cell Lung Cancer Focusing on the Preoperative Glasgow Prognostic Score

Abstract

Background: The Glasgow Prognostic Score (GPS), which consists of albumin and C-reactive protein (CRP), may predict overall survival (OS) in cancer patients. The aim of this retrospective analysis was to evaluate the clinical impact of the preoperative GPS on patients with resected early stage non-small cell lung cancer (NSCLC). Methods: 300 patients with curatively resected stage I NSCLC were followed-up for OS, recurrence-free survival (RFS), cancer-specific survival (CSS), and death from other causes. Results: 229 patients (76%) had a preoperative GPS of 0, and 71 (24%) a GPS ≥ 1. The three-year probabilities of RFS, OS, CSS, and death from other causes were 81%, 84%, 88%, and 96% in patients with GPS = 0, and 79%, 74%, 91%, and 82% in patients with a GPS ≥ 1, respectively. GPS ≥ 1 was significantly associated with a higher risk of death from other causes (p = 0.022), serving as an independent predictor of death from other causes (p = 0.034). Pathologically elevated CRP levels (CRP > 5 mg/L) were found in 91 patients (30%). The mean CRP level was 7.88 ± 15.80 mg/L (0.5–135.6 mg/L). Pre-treatment CRP level was significantly associated with coronary heart disease (p < 0.0001), histology (p = 0.013), tumor size (p = 0.018), tumor stage (p = 0.002), and vascular invasion (p = 0.017). Conclusion: The preoperative GPS predicts adverse survival outcomes in patients with resected stage I NSCLC.

A Meta-Analysis of Glasgow Prognostic Score and Modified Glasgow Prognostic Score as Biomarkers for Predicting Survival Outcome in Renal Cell Carcinoma

“…Furthermore, undernutrition is associated with a poor prognosis (38). Since the initial studies used the systemic inflammatory response, an independent prognostic value has been reported for operable colorectal cancer (39), as well as gastrointestinal cancer (9), non-small cell lung cancer (10), colorectal neoplasms (11), urothelial carcinoma (12), and RCC (13). An early study (40) reported that albumin levels decreased as circulating CRP levels increased, and this relationship was observed in multiple types of tumors.…”

“…Compared to the conventional combination of stage and performance status CRP and albumin levels ( 7 ), the combination of organismic inflammatory response and albumin levels was found to have a comparable prognostic value. In addition, GPS and mGPS were useful for the prognosis of various solid tumors, including gastrointestinal cancer ( 10 ), non-small cell lung cancer ( 11 ), colorectal neoplasms ( 12 ), urothelial carcinoma ( 13 ), as well as RCC ( 14 ).…”

C-Reactive Protein (CRP) Levels in Immune Checkpoint Inhibitor Response and Progression in Advanced Non-Small Cell Lung Cancer: A Bi-Center Study

“…Elevated levels of baseline C-reactive protein (CRP), a marker of systemic inflammation and immune activation, are associated with poor treatment response to chemotherapy and adverse disease outcome in various cancers including advanced NSCLC [ 13 , 14 , 15 , 16 ]. We can conceive a strong biologic rationale on how elevated CRP may be a proxy marker for adverse immunotherapy outcomes and disease progression in NSCLC.…”

Links between Inflammation and Postoperative Cancer Recurrence

“…Based on these results, the aforementioned study concluded that the pretreatment ALI was indicative of poor prognosis among patients with NSCLC, suggesting its potential utility as a tumor marker for survival prediction among the same patients [ 40 ]. The Glasgow Prognostic Score (GPS), which includes albumin and CRP levels, can predict postoperative survival in stage I and advanced NSCLC patients [ 41 , 42 , 43 ]. Therefore, these clinical indices are reliable predictive markers for post-treatment survival in lung cancer.…”