The Glasgow Prognostic Score (GPS) As a Significant Predictor of Diffuse Large B Cell Lymphoma Treated with the R-CHOP in China

Abstract

Background: The Glasgow Prognostic Score (GPS), consisting of C-reactive protein (CRP) and albumin (Alb), is clinically useful for tumor behavior and shows significant prognostic value in several types of tumors. Several studies showed that GPS could be a predictive marker for advanced solid tumor, such as colorectal cancer, gastric cancer, etc. Now we performed a retrospective study to evaluate the relationship between GPS and prognosis of 160 patients with diffuse large B cell lymphoma (DLBCL) receiving R-CHOP chemotherapy between January 2001 and May 2010 at Shanghai Ruijin Hospital.Methods: Before treatment, the CRP and albumin were both tested for base line. Patients with both elevated CRP level (>10 mg/L) and hypoalbuminemia (<35 g/L) were given a score of 2. Patients with only one of these two biochemical abnormalities were allocated a score of 1. Patients in whom neither of these abnormalities was presented received a score of 0. We also identified International Prognostic Index (IPI) score of these patients.Results: Patients were assorted into three groups based on GPS at diagnosis. Survival curves were performed using the Kaplan-Meier method. Results showed that the overall survival (OS) and progress-free survival (PFS) rates for all patients were 78.1% and 68.1%, respectively. Analyzed by log-rank test, there was significant difference between GPS 1, GPS 2 and GPS 3 for OS (90.8% vs. 76.6% vs. 38.5%, p<0.001) and PFS (86.2% vs. 66.0% vs. 15.4%, p<0.001) (Fig 1a and b). In addition, the IPI, as a well-accepted prognostic system, though showed significant difference between lower risk group (IPI 0-2) and higher risk group (IPI 3–5) for OS (89.1% vs. 54.0%, p<0.01), failed to identify patients with poor prognosis in the lower risk group, since the low risk (IPI=0-1) and low-intermediate risk groups (IPI=2) appeared closely overlapping (p>0.05). While combining with the IPI model, GPS can have powerful prognostic value in the lower-risk (IPI=0-2) DLBCL patients, since patients with GPS score=0 had better OS (P<0.001) and PFS (P<0.001) than those with GPS score=1–2(Fig 2a and b).Conclusion: The GPS was a reliable and independent predictor of OS and PFS in patients with DLBCL treated with R-CHOP regimen. GPS combining with the IPI score may offer a more integrated prognostic system in the rituximab era of DLBCL. And inflammatory response might play an important role in the progression and survival of patients with DLBCL. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.