Einfluss vom Glasgow Prognostic Score auf das perioperative Outcome und das Langzeitüberleben beim Ösophaguskarzinom

Abstract

Objective: Systemic inflammation (SI) plays a pivotal role in cancer. C-reactive protein (CRP) and albumin as parameters of SI form the Glasgow Prognostic Score (GPS). GPS is associated with poor clinical outcome in several tumor types. The aim of the study was to evaluate the potential prognostic role of GPS in a homogeneous population of esophageal cancer (EC) patients undergoing only resection without neoadjuvant or adjuvant treatment. Patients and Methods: GPS was evaluated on the basis of admission blood sample taken prior to surgery. Patients with a CRP (< 10 mg/L) and albumin (> 35 g/L) were allocated a GPS of 0 (GPS0). If only CRP was increased or albumin decreased patients were allocated to the GPS1 group. Patients in whom CRP was ≥ 10 mg/L and albumin level ≤ 35 g/L were classified as GPS2. GPS was correlated to clinicopathological parameters and clinical outcome. Results: Increasing GPS significantly correlated with more aggressive tumor biology in terms of tumor size (P < 0.001), presence of regional (P = 0.01) and non-regional lymph node metastasis (P = 0.02) and higher tumor recurrence rate (P < 0.001). Furthermore, GPS was identified as an independent prognosticator of perioperative morbidity (odds ratio 1.9; P = 0.03). In addition, a gradual decrease in DFS and OS was evident between the three GPS subgroups. Survival differences between the GPS groups remained apparent even after stratification of the study population to underlying tumor type and nodal status. GPS was identified as a strong prognosticator of tumor recurrence (hazard ratio 3.0; P < 0.001) and survival (hazard ratio 2.5; P < 0.001) in EC. Conclusion: GPS represents a strong prognosticator of perioperative morbidity and long-term outcome in EC patients without neoadjuvant or adjuvant treatment.