Elevated Glasgow Prognostic Score Research Articles

Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer

In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations. The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL. Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) ≥1 (p=0.046) and number of stapler firings ≥3 (p=0.002) were associated with AL. In multivariate analysis, only GPS ≥1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905). DS creation is effective for avoiding reoperation for AL. Preoperative GPS ≥1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.

Prognostic Assessment of Colorectal Cancer Patients after Laparoscopic Surgery: A Comprehensive Evaluation of the Glasgow Prognostic Score and Fibrinogen-to-Prealbumin Ratio.

BACKGROUND Previous studies have shown that systemic inflammation and suboptimal nutritional status are associated with poor cancer prognosis. This study aims to investigate the prognostic value of preoperative Glasgow prognostic score (GPS) and fibrinogen-to-prealbumin ratio (FPR) in patients with CRC (colorectal cancer) after laparoscopic surgery. MATERIAL AND METHODS In this study, the clinical data of 112 patients with CRC who underwent laparoscopic surgery were retrospectively analyzed, and the 3-year and 5-year survival rates of these patients were evaluated. In addition, the prognostic role of preoperative FPR and GPS in CRC patients was assessed using X-tile software, Kaplan-Meier analysis, and Cox regression analysis. Receiver operating characteristic (ROC) curves were generated to assess the predictive value of FPR, GPS, and FPR-GPS for the survival of these patients. RESULTS The results revealed a significant negative correlation between high FPR, elevated GPS, and overall survival (OS) in patients with CRC. Univariate and multivariate Cox regression analyses identified GPS (HR=3.207, 95% CI: 1.746~6.126), FPR (HR=2.669, 95% CI: 1.052~6.772), and lymph node metastasis (HR=2.222, 95% CI: 1.199~4.115) as independent prognostic indicators for overall survival. The ROC analysis demonstrated that the prediction based on FPR and GPS outperformed a single indicator in accurately predicting the prognosis of CRC patients. CONCLUSIONS Combining the preoperative FPR with the GPS contributes to accurate prognosis assessment for CRC patients after laparoscopic surgery. Patients exhibiting high FPR and GPS values are associated with a worse prognosis.

Glasgow Prognostic Score Predicts Survival and Recurrence Pattern in Patients With Hepatocellular Carcinoma After Hepatectomy.

The prognostic significance of the Glasgow Prognostic Score (GPS) on outcomes of liver resection for hepatocellular carcinoma (HCC) remains unclear; the aim of the study was to assess its significance. A total of 480 patients with HCC who underwent liver resection with curative intent at the Yokohama City University Hospital and Medical Center were enrolled in the study. Patients were classified into three groups: GPS-0, C-reactive protein (CRP) ≤1.0 mg/dl serum albumin ≥3.5 g/dl; GPS-1, CRP >1.0 mg/dl or serum albumin <3.5 g/dl; and GPS-2, CRP >1.0 mg/dl, serum albumin <3.5 g/dl. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively. The recurrence pattern was also investigated using GPS. Of the 480 patients, 382 (79.6%), 81 (16.9%), and 17 (3.5%) were assigned to GPS-0, GPS-1, and GPS-2, respectively. Elevated GPS, indocyanine green retention rate at 15 min, and protein induced by vitamin K antagonist-II (PIVKA-II) were significantly associated with a poor OS. Elevated GPS, alpha-fetoprotein, and PIVKA-II were significantly associated with a poor DFS by multivariate analysis. The number of patients with liver-only recurrence in GPS-0, GPS-1, and GPS-2 was 179 (86.1%), 40 (78.4%), and 9 (69.2%), respectively. The number of patients with four or more intrahepatic metastases in the GPS-0, GPS-1, and GPS-2 groups, was 33 (17.9%), 11 (27.5%), and 8 (88.9%), respectively. The number of patients with four or more intrahepatic metastases in the GPS-2 group was significantly higher (p<0.001). Preoperative GPS is a useful predictor of OS and recurrence pattern after liver resection with a curative intent for HCC.

Glasgow prognostic score and combined positive score for locally advanced rectal cancer.

PurposeThis study was performed to investigate the association of Glasgow prognostic score (GPS), combined positive score (CPS), and clinicopathological characteristics of locally advanced rectal cancer.MethodsBetween February 2012 and February 2018, 103 patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and total mesorectal excision (TME) were retrospectively evaluated.ResultsAccording to the classification of the GPS, 85 (82.5%), 13 (12.6%), and 5 patients (4.9%) were classified as a score of 0, 1, and 2, respectively. Patients were classified into the GPS-low group (GPS of 0, n = 85) and GPS-high group (GPS of 1 or 2, n = 18) with an area under the curve of 0.582 for overall survival (OS). The mean programmed death-ligand 1 (PD-L1) CPS of the whole group was 2.24 (range, 0–70). The PD-L1 CPS of the GPS-high group was higher than the GPS-low group (P < 0.001). Multivariate analysis by Cox proportional hazards model indicated that GPS was associated with OS and disease-free survival (DFS). Furthermore, PD-L1 CPS was associated with DFS (hazard ratio, 1.050; 95% confidence interval, 1.017–1.083; P = 0.003).ConclusionElevated GPS was related to the PD-L1 CPS. GPS and PD-L1 CPS were associated with the prognosis of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by TME.

C-Reactive Protein and C-Reactive Protein-Based Scores to Predict Survival in Esophageal and Junctional Adenocarcinoma: Systematic Review and Meta-Analysis.

Esophageal adenocarcinoma (EAC) has a poor prognosis; predictive markers of prognosis would facilitate advances in personalized therapy. C-reactive protein (CRP) and CRP-based scores are increasingly recommended across oncology; however, their role and value in EAC is unclear. This systematic review and meta-analysis examined CRP cut-point and scores and how they may best be applied in predicting survival in EAC. A systematic literature search was conducted in EMBASE, Medline, Web of Science, Cochrane, Scopus and CINAHL databases, from inception to 1st October 2020. Studies reporting data from adults with EAC including adenocarcinoma of the gastro-esophageal junction (AEG), pre-treatment CRP or CRP-based score and Hazard Ratio (HR) for survival were included. QUIPS tool assessed risk of bias. Meta-analysis was undertaken. A total of 819 records were screened. Eight papers were included, with data for 1475 people. CRP cut-points ranged from 2.8 to 10 mg/L. The Glasgow Prognostic Score (GPS) and modified GPS were the most commonly reported scores. On meta-analysis, elevated preoperative GPS/mGPS was significantly associated with worse overall survival (hazards ratio [HR] 1.81, 95% confidence interval [CI] 1.25-2.62, p = 0.002); results were similar in subgroup analyses of multimodal treatment, M0 disease, and R0 resection. This is the first review to evaluate comprehensively the evidence for CRP and CRP-based scores in EAC. Meta-analysis demonstrated that elevated preoperative GPS or mGPS was significantly associated with reduced overall survival in EAC, including AEG. There is insufficient evidence to support use of CRP alone. Future studies should examine GPS/mGPS in EAC prospectively, alone and combined with other prognostic markers.

Systemic Inflammatory Markers for Predicting Overall Survival in Patients with Osteosarcoma: A Systematic Review and Meta-Analysis.

Background Inflammatory markers are associated with tumor genesis and progression, but their prognostic significance in osteosarcoma remains unclear. Therefore, we discussed the prognostic value of related inflammatory markers in osteosarcoma through a meta-analysis and systematic review. These inflammatory markers include C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and Glasgow prognostic score (GPS). Methods The Chinese National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journals (VIP), PubMed, Embase, and Cochrane libraries were searched. The design of meta-analysis was made based on the PICOS (population, intervention/exposure, control, outcomes, and study design) principles, and STATA 15.1 was used to analyze the data. The Newcastle-Ottawa scale (NOS) was used to assess the quality of included studies. Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DPS) were extracted for the investigation of the prognostic value of inflammatory markers. Results Twelve researches with 2162 osteosarcoma patients were included in total. The pooled results showed that elevated NLR, CRP, and GPS are all greatly related to shortening of OS among patients with osteosarcoma (HR = 1.68, P = 0.007, 95% CI: 1.15-2.45; HR = 1.96, P = 0.002, 95% CI: 1.28-3.00; HR = 2.54, P < 0.0001, 95% CI: 1.95-3.31, respectively), and CRP level is significantly associated with shortening of DPS among patients with osteosarcoma (HR = 2.76, 95% CI:2.01-3.80, P < 0.0001), additionally. However, the correlation between LMR or PLR and the prognosis of osteosarcoma is not statistically significant (HR = 0.60, 95% CI: 0.30-1.18, P = 0.138; HR = 1.13, 95% CI: 0.85-1.49, P = 0.405, respectively). The outcomes of subgroup analysis to NLR and CRP suggested that histology, ethnicity, metastasis, and sample size all have an impact on its prognosis of patients with osteosarcoma. Conclusion Worsened prognosis may be related to high levels of NLR, CRP, and GPS before treatment rather than LMR or PLR, which can provide the basis for clinicians to judge the outcomes of prognosis. Trial Registration. PROSPERO (CRD42021249954), https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249954.

Prognostic Value of Pretreatment Glasgow Prognostic Score/Modified Glasgow Prognostic Score in Ovarian Cancer: A Systematic Review and Meta-Analysis

Purpose: To explore prognostic value of pretreatment Glasgow prognostic score (GPS) and modified Glasgow prognostic score (mGPS) in ovarian cancer patients. Methods: The PubMed, EMBASE (via OVID), and Web of Science databases were comprehensively searched for eligible studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to evaluate the association of pretreatment GPS/mGPS with overall survival (OS) and progression-free survival (PFS) of ovarian cancer patients. STATA 12.0 version software was applied for statistical analysis. Results: A total of eight retrospective studies involving 2260 were included into this systematic review and meta-analysis. The pooled results indicated that patients with elevated pretreatment GPS or mGPS had poorer OS (HR = 1.62, 95% CI: 1.38–1.91, P＜.001) and PFS (HR = 1.40, 95% CI: 1.02–1.93, P = .039) than patients with pretreatment GPS or mGPS 0. Subgroup analysis based on the type of score (GPS or mGPS) and tumor stage for OS were also performed and the results were consistent with above findings. Conclusion: Pretreatment GPS/mGPS might serve as promising prognostic indexes for ovarian cancer patients. More prospective studies with high-quality are needed to verify our findings.

Can Glasgow score predict mortality in patients with chronic obstructive pulmonary disease with acute exacerbation?

Background The study was planned to investigate the importance of Glasgow prognostic score (GPS) in cases that require hospitalization owing to chronic obstructive pulmonary disease (COPD) acute attack. Patients and methods The study retrospectively conducted 223 patients with acute exacerbation of COPD. Based on the data obtained from the files, the requirement of transfer to intensive care and death in hospital was considered as negative results. Results In total, 233 cases were involved in this study. A total of 194 (83.3%) of the patients were male, and 39 (16.7%) were female. GPS of 0, 1, and 2 were observed in 36, 112, and 85 patients, respectively. Cox regression analysis indicated that hospitalization in ICU (P=0.000, odds ratio: 7.45, confidence interval: 4.77–11.53%) and GPS 2 (P=0.11, odds ratio: 3.34, confidence interval: 1.314–8.52%) are independent risk factors for negative results of acute exacerbation. Survival times were shorter at significant levels in GPS 2 group. Conclusion It was found that elevated GPS values are associated with increased hospital mortality risk. GPS is a universally available, low-cost method and may be used as a prognostic marker for short-term hospital mortality in patients with acute exacerbation of COPD.

Preoperative inflammation-based scores predict early recurrence after lung cancer resection.

BackgroundInflammation in the tumor microenvironment is hypothesized to have a major role in cancer invasiveness, progression, and metastases. The purpose of this study was to evaluate the prognostic value of preoperative inflammation-based scores in terms of estimating the timing of recurrence by hazard curves in a cohort of operable, early-stage non-small cell lung cancer (NSCLC) patients.MethodsA total of 387 patients with NSCLC who underwent complete pulmonary resection from 2010 to 2019 had their C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index (SII), and advance lung cancer inflammation index (ALI) measurements taken before surgery. Hazard curves indicating changes in hazards over time were evaluated.ResultsMedian follow-up was 39.2 months. In total, 105 patients (27.1%) experienced recurrence. The resulting hazard curve with elevated CAR, SII, GPS, and mGPS, values displayed an initial high peak during the first year. Multivariate analyses showed that an elevated CAR [hazard ratio (HR), 1.987; 95% confidence interval (CI), 1.202–3.284] independently predicted the recurrence-free survival. Even in stage I disease, patients with elevated CAR and SII values showed an earlier peak of recurrence, which was about 12 to 16 months earlier than those with low values.ConclusionsEven after complete resection of stage I NSCLC, patients with elevated CAR and SII values retain a high risk of early recurrence. Preoperative inflammation-based scores can be an objective, simple, and cost-effective measurement for predicting early recurrence of NSCLC.

Prognostic Utility of the Glasgow Prognostic Score for the Long-Term Outcomes After Liver Resection for Intrahepatic Cholangiocarcinoma: A Multi-institutional Study.

The usefulness of the modified Glasgow prognostic score (GPS) as a prognostic tool remains unclear for patients undergoing curative surgery for intrahepatic cholangiocarcinoma (ICC). Therefore, this study investigated the prognostic usefulness of the GPS for patients who underwent ICC surgery. All ICC patients who had a curative-intent hepatectomy at 17 institutions between 2000 and 2016 were included. The correlation was assessed between the preoperative GPS and the baseline characteristics of the patients, histopathological parameters, surgical parameters, and the postresection overall survival (OS). There were 273 patients who met the eligibility criteria between the years 2000 and 2016. The postoperative OS rates at 1, 3, and 5years were 83.8%, 56.3%, and 41.5%, respectively (median OS, 47.7months). A multivariate analysis revealed the factors that were associated with a worse OS, which included an increased GPS (hazard ratio = 1.62; 95% confidence interval [CI]: 1.01-2.53; P = 0.03), an elevated carcinoembryonic antigen level (hazard ratio = 1.60; 95% CI: 1.06-2.41; P = 0.02), an elevated carbohydrate antigen 19-9 level (hazard ratio = 1.55; 95% CI: 1.05-2.30; P = 0.03), undifferentiated carcinoma (hazard ratio = 2.41; 95% CI: 1.56-3.67; P < 0.01), and positive metastasis to the lymph nodes (hazard ratio = 2.54; 95% CI: 1.76-3.67; P < 0.01). In ICC patients after a hepatectomy, an elevated GPS was associated with poorer OS, even if the tumour factors that affected GPS were eliminatedbypropensity-score matching. Preoperative GPS can be useful to predict the postoperative outcomes of ICC patients. Therefore, this relatively simple and inexpensive scoring system can be utilized to further refine patient stratification as well as to predict survival.

The Prognostic Role of Glasgow Prognostic Score and C-reactive Protein to Albumin Ratio for Sarcoma: A System Review and Meta-Analysis

Backgrounds Both pretreatment serum CRP (C-reactive protein) level and ALB (albumin) level have been found to be predictive of survival for multiple malignancies including sarcoma. Since both of the GPS (Glasgow prognostic score) and CAR (C-reactive protein to albumin ratio) are based on the combination of CRP and ALB, we conducted a meta-analysis to evaluate the prognostic role of these two parameters for sarcoma patients. Methods A detailed literature search was conducted in MEDLINE, Embase, and Cochrane Library for relevant research publications written in English. Patients' clinical characteristics, outcomes of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were extracted. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were combined to evaluate the prognostic role of GPS or CAR. Results Twelve articles containing 2695 patients were identified as eligible studies. The results showed that an elevated GPS was significantly correlated with poor OS (HR = 2.42; 95% CI: 1.98-2.94; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), and DFS (HR = 2.05; 95% CI: 1.62-2.60; p < 0.001; fixed-effects model). A higher CAR also was shown to be significantly correlated with poor OS (HR = 2.23; 95% CI: 1.70-2.92; p < 0.001; fixed-effects model) and DFS (HR = 1.81; 95% CI: 1.7-2.58; p = 0.001; fixed-effects model). Conclusion An elevated GPS is predictive of poor survival in patients with sarcomas and is promising to be used as a factor for risk stratification. A higher CAR value is also predictive of poor survival; however, the optimal CAR cut-off value is still to be determined.

The prognostic value of pretreatment Glasgow Prognostic Score in patients with esophageal cancer: a meta-analysis.

ObjectivesTo examine the predictive role of Glasgow Prognostic Score (GPS) on long-term survival in esophageal cancer.MethodComprehensive searches of electronic databases were performed to identify potential studies that evaluated the prognostic value of pretreatment GPS in esophageal cancer patients. We combined the hazard ratios (HRs) with 95% confidence intervals (CIs) to assess the association of GPS with overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS).ResultsA total of 21 studies including 6115 patients were analyzed. Compared with patients with GPS 0, patients with elevated GPS had poorer OS (HR =2.12, 95% CI: 1.83–2.45, P<0.001) and CSS (HR =2.16, 95% CI: 1.56–2.98, P<0.001); but no significant relationship was observed between the elevated GPS and DFS (HR=2.14, 95% CI:1.00–4.61, P=0.051). Subgroup analysis outcomes were similar to overall analyses.ConclusionPretreatment GPS could serve as a valuable factor in predicting the prognosis of patients with esophageal cancer. More well-designed prospective studies are warranted to confirm our findings.

Prognostic markers affecting the early recurrence of hepatocellular carcinoma with liver cirrhosis after curative resection.

Early recurrence is associated with poor prognosis after curative resection for hepatocellular carcinoma. Thus, we studied which factors, including this inflammation-based scoring system, affect disease recurrence in single hepatocellular carcinoma patients with liver cirrhosis. A total of 430 consecutive hepatocellular carcinoma patients were enrolled in our institution between January 2002 and December 2015. Survival rate, univariate, and multivariate analyses were performed to identify the variables associated with recurrence and early recurrence especially. The overall survival rate was significantly lower in the early recurrence group than in the non-early recurrence group (P<0.001). According to the multivariate analysis, protein induced by vitamin K absence or antagonist (PIVKA) greater than 200 (P=0.035), neutrophil-to-lymphocyte ratio greater than 2.0 (P<0.001), elevated Glasgow prognostic score (P=0.003), tumor size greater than 5 cm (P=0.002), and the presence of lymphovascular invasion (P=0.002) were significantly different among the groups and affected the early recurrence of hepatocellular carcinoma. The patients were categorized into five levels of risk for early recurrence according to the number of independent risk factors, and patients with no risk factors were set as the reference group. Neutrophil-to-lymphocyte ratio, Glasgow prognostic score, and serum level of PIVKA offer significant prognostic information associated with early recurrence following single lesion hepatocellular carcinoma patients with liver cirrhosis after curative resection.

Prognostic significance of nutritional and inflammatory markers in patients with locally advanced unresectable (UR-LA) pancreatic ductal adenocarcinoma treated with chemotherapy

Introduction: Several nutritional and inflammatory markers have been reported to be involved in cancer progression. The aim of this study is to evaluate whether nutritional and inflammatory biomarkers such as the Glasgow prognostic score (GPS), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the systemic-immune-inflammation index (SIII), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and the lymphocyte-to-monocyte ratio (LMR) could predict the prognosis in patients with locally advanced unresectable pancreatic ductal adenocarcinoma (UR-LA PDAC) who underwent chemotherapy as first-line therapy, using disease-specific survival as the primary outcome. Method: All UR-PDAC patients were retrospectively evaluated between January 2011 and May 2017 at Toyama University Hospital. Baseline clinicopathological characteristics and pre-treatment laboratory values such as absolute neutrophil, lymphocyte and platelet counts, C-reactive protein, albumin and CA19-9 levels, were collected. Result: A total of 175 patients were diagnosed as UR-PDAC, and 36 patients were diagnosed as UR-LA PDAC. Among them, 34 patients who underwent chemotherapy were enrolled in this study. There were significant relationships between poor survival and elevated GPS, elevated PLR, decreased PNI, elevated SIII, decreased LMR, and low CONUT score (p=0.008, p=0.002, p=0.019, p=0.001, p=0.039, and p=0.038, respectively, by log-rank test). The median survival time of patients with GPS score of 0-1 was significantly longer than that of patients with GPS score of 2 (23.7 vs 13.4 months, respectively). There was no significant difference in survival in pre-treatment CA19-9 level, tumor location, maximum tumor diameter, and additional radiotherapy. Multivariate analysis using Cox regression model revealed that GPS was an independent prognostic factor. Conversion surgery was performed after successful downstaging in 4 patients (12%). Conclusion: Pre-treatment GPS may predict clinical outcome in patients with UR-LA PDAC undergoing chemotherapy as first-line therapy.

Prognostic value of the Glasgow prognostic score in colorectal cancer: a meta-analysis of 9,839 patients.

PurposeThe aim of this study was to perform a systematic review and meta-analysis to evaluate the value of the Glasgow prognostic score (GPS) or modified Glasgow prognostic score (mGPS) in patients with colorectal cancer (CRC).MethodsA comprehensive medical literature search was performed using the online databases PubMed, Embase, Web of Science, and the Cochrane Library. After extracting basic characteristics and prognostic data from the included studies, overall survival (OS) and cancer-specific survival (CSS) were pooled as primary outcomes. Subgroup analyses were performed according to therapeutic strategies, models, cutoff values, regions, tumor, node, metastasis stages, sample size, and ages.ResultsForty-three independent cohorts from 41 studies with 9,839 CRC patients were included in the present study. Correlation between GPS or mGPS and OS was analyzed in 32 cohorts of 7,714 patients, and 23 independent cohorts of 5,375 patients focused on the correlation between GPS or mGPS and CSS. The overall outcomes showed that patients with elevated GPS or mGPS were associated with poor OS (HR: 2.20, 95% CI: 1.88–2.57, P<0.001). Elevated GPS or mGPS also resulted in worse CSS (HR: 1.86, 95% CI: 1.59–2.17, P<0.001). The results of the subgroup analyses confirmed the overall outcomes.ConclusionGPS or mGPS is an accurate prognostic predictor in patients with CRC. Patients with elevated pretreatment GPS or mGPS have a poor prognosis. Subgroup analyses confirmed the overall outcomes. Pretreatment GPS is a useful biomarker in the management of CRC.

Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis

BackgroundInflammation-based prognostic scores have been used as outcome predictors in patients with cancer or on hemodialysis. However, their role in patients on continuous ambulatory peritoneal dialysis (CAPD) remains unclear. This study aimed to examine the prognostic value of inflammation-based composite scores for mortality in CAPD patients.MethodsThis study was conducted in CAPD patients enrolled from January 1, 2006 to December 31, 2014 and followed until December 31, 2016. Three inflammation-based prognostic scores, including Glasgow prognostic score (GPS), prognostic nutritional index (PNI), and prognostic index (PI), were conducted in this study. The associations between these scores and all-cause or cardiovascular mortality were evaluated by Kaplan–Meier method and Cox proportional hazards models. The areas under the curve (AUC) of receiver-operating characteristic (ROC) analysis were used to determine the predictive values of mortality.ResultsA total of 1501 patients were included. During a median follow-up of 38.7 (range, 21.6–62.3) months, 346 (23.1%) patients died, of which 168 (48.6%) were due to cardiovascular diseases (CVD). After adjustment for confounders, the results showed that elevated GPS, PNI, and PI scores were all independently associated with all-cause [GPS: Score 1: hazard ratio(HR) 3.94, 95% confidence interval(CI) 2.90–5.35; Score 2: HR 7.56, 95% CI 5.35–10.67; PNI: HR 1.82, 95% CI 1.36–2.43; PI: Score 1: HR 2.08, 95% CI 1.63–2.65; Score 2: HR 3.03, 95% CI 2.00–4.60)] and CVD mortality(GPS: Score 1: HR 4.41, 95% CI 2.76–7.03; Score 2: HR 9.64, 95% CI 5.72–16.26; PNI: HR 1.63, 95% CI 1.06–2.51; PI: Score 1: HR 2.57, 95% CI 1.81–3.66, Score 2: HR 3.85, 95% CI 1.99–7.46).The AUC values of GPS score were 0.798 (95% CI0.770–0.826) for all-cause mortality and 0.781 (95% CI 0.744–0.817) for CVD mortality, both of which significantly higher than those of PNI and PI scores (P < 0.001, respectively).ConclusionsAll elevated GPS, PNI, and PI scores were independently associated with all-cause and CVD mortality. The GPS score showed better predictive value than PNI and PI scores in CAPD patients.

Prognostic significance of pre-operative inflammatory markers in resected gallbladder cancer: a systematic review.

Neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and Glasgow Prognostic Score (GPS) have demonstrated good prognostic value in several cancers but their role in gallbladder cancer (GBC) remains unclear. The aim of this study is to systematically review the current literature to determine their role in predicting survival outcomes in GBC. Using a pre-specified inclusive search strategy MEDLINE, EMBASE and CINAHL databases were used to identify studies describing survival in patients after GBC resection with high or low pre-operative CRP, GPS or NLR. A proforma was used to extract study author and date, number of patients, age, gender, tumour stage, use of adjuvant therapy and primary outcome data. In all, 46 studies were identified after initial screening with four studies reporting survival outcomes. All studies described a reduction in survival in patients with an elevated NLR, GPS or CRP. Three studies showed NLR to be an independent prognostic marker and one study additionally demonstrated that elevated CRP and GPS were associated with poorer survival. Elevated pre-operative inflammatory markers are inversely related to survival outcomes. They are relatively inexpensive, easy measurable parameters that could aid in the decision making process involved in the management of GBC. Sub-stratification of groups utilizing inflammatory markers may help guide surgical strategy. However, these studies are retrospective and of low to moderate quality. High quality, prospective studies with well-defined inclusion criteria and outcomes are needed to guide the role of inflammatory markers in the management of GBC.

Prognostic value of the Glasgow prognostic score in lung cancer: evidence from 10 studies.

To conduct a meta-analysis of prospective and retrospective studies to reveal the relationship between the Glasgow prognostic score (GPS) and overall survival (OS) or progression-free survival (PFS) in patients with lung cancer. Correlative studies were included by searching the databases of PubMed, Web of Science, Embase, and PubMed Cochrane Library until April 16, 2017. We combined the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between GPS and OS or PFS in patients with lung cancer. Ten studies involving 5,369 participants from several regions were identified through searching databases. In a pooled analysis of all studies, elevated GPS was associated with poorer OS (HR = 2.058; 95% CI, 1.51-2.80; p<0.05). However, the combined data showed no significant relationship between the GPS of 1 or 2, and PFS, respectively. Subgroup analysis showed that the patients with GPS ≥1 had poorer OS compared with those with GPS = 0 (HR = 2.01; 95% CI, 1.75-2.32; p<0.001). A similar trend was observed in patients receiving chemotherapy (HR = 1.66; 95% CI, 1.17-2.36; p<0.05) and surgery (HR = 2.88; 95% CI, 1.59-5.22; p<0.001) when stratified by treatment. Increased level of GPS may have a prognostic value in lung cancer. We detected a statistical difference in the association of elevated GPS and poorer OS, though the association was not significant in PFS settings. However, further studies are warranted to draw firm conclusions.

Prognostic role of Glasgow prognostic score in patients with colorectal cancer: evidence from population studies

Glasgow prognostic score (GPS) has been reported to be an indicator of prognosis for various cancers. However, the relationship between GPS and colorectal cancers (CRC) remains unclear. A comprehensive search of Pubmed, Embase, Cochrane library, Web of Science, ChinaInfo and Chinese National Knowledge Infrastructure was performed to identify eligible studies, from which the risk of overall survival (OS) and cancer-specific survival (CSS) were extracted. A random-effect model was adopted to combine hazard ratio (HR) and 95% confidence interval (CI). 25 articles with a total of 5660 participants were included. The pooled results indicated that elevated GPS was associated with poor OS (HR = 2.83, 95%CI: 2.00–4.00, P < 0.01) and CSS (HR = 1.94, 95%CI: 1.51–2.49, P < 0.01). This correlation was confirmed both in primary operable and advanced inoperable patients. Increased GPS was also closely related to advanced tumour-node-metastasis (TNM) stage (odds ratio [OR] = 1.44, 95% CI: 1.010–2.065, P < 0.05) and elevated level of serum carcinoembryonic antigen (OR = 2.252, 95% CI: 1.508–3.362, P < 0.01). Subgroup analysis revealed a significant association between high GPS and poor survival outcome according to the factors of sample size, study of region and cut-off value of GPS level. These findings suggest that GPS may serve as a reliable predictive index for patients with CRC.

Glasgow Prognostic Score and Prognosis After Hepatectomy for Hepatocellular Carcinoma.

Systemic inflammation can promote tumor growth. The Glasgow Prognostic Score (GPS), a simple assessment of systemic inflammation status, could be useful to predict the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy. Consecutive HCC patients were enrolled following hepatectomy at our institution between 2005 and 2012. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS) and recurrence-free survival. Patients were stratified according to the GPS. To minimize selection bias, propensity score analysis was performed. An elevated GPS (1-2), des-gamma carboxyprothrombin levels (≥40 mAU/mL), and the presence of multiple tumors were significantly associated with a poor OS. Alpha-fetoprotein levels (≥20.0ng/mL), des-gamma carboxyprothrombin levels (≥40 mAU/mL), and the presence of multiple tumors were independent risk factors for a poor recurrence-free survival. After one-to-one matching, 92 patients each with a normal GPS (0) and an elevated GPS (1-2) had similar preoperative and operative characteristics. Poorer OS times in patients with an elevated GPS were confirmed by excluding possible misinterpretation. An elevated GPS was an independent prognostic indicator for OS after hepatectomy in HCC patients. The GPS, which employs inexpensive and readily available biomarkers, could be a novel tool for predicting survival in such patients.