Preoperative mGPS Research Articles

Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer.

We evaluated prognostic indicators based on inflammatory and nutritional factors, namely, the modified Glasgow Prognostic Score (mGPS), the Prognostic Nutritional Index (PNI), the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR), to determine their efficiency and significance after pancreaticoduodenectomy for pancreatic cancer. The subjects of this study were 46 patients who underwent pancreaticoduodenectomy for pancreatic cancer between October 2007 and December 2014. Patients were divided into preoperative mGPS (0/1 and 2), PNI (<40 and ≥40), NLR (<2.5 and ≥2.5), and PLR (<200 and ≥200) groups, to evaluate various perioperative outcomes. Hemoglobin concentrations were significantly lower (P=0.019), whereas intra-abdominal bleeding was significantly higher (P=0.040) in the PNI (<40) group than in the PNI (≥40) group. The incidence of postoperative pneumonia was significantly higher in the mGPS (2) group (P=0.009), and surgical complications greater than grade 3 (Clavien-Dindo classification) were significantly increased in the NLR (≥2.5) group (P=0.041). Overall survival rates in the PNI (<40) (P=0.019), NLR (≥2.5) (P=0.001), and PLR (≥200) (P<0.001) groups were significantly lower than those in the other groups. The PLR was the only independent prognostic indicator (P=0.002) according to multivariate analysis. The mGPS, PNI, and NLR were effective predictive indicators of postoperative complications. The PLR was the most useful prognostic indicator for pancreatic cancer patients after pancreaticoduodenectomy.

Modified Glasgow Prognostic Score is Associated With Risk of Recurrence in Bladder Cancer Patients After Radical Cystectomy: A Multicenter Experience.

Recently, many studies explored the role of inflammation parameters in the prognosis of urinary cancers, but the results were not consistent. The modified Glasgow Prognostic Score (mGPS), a systemic inflammation marker, is a prognostic marker in various types of cancers. The aim of the present study was to investigate the usefulness of the preoperative mGPS as predictor of recurrence-free (RFS), overall (OS), and cancer-specific (CSS) survivals in a large cohort of urothelial bladder cancer (UBC) patients.A total of 1037 patients with UBC were included in this study with a median follow-up of 22 months (range 3–60 months). An mGPS = 0 was observed in 646 patients (62.3%), mGPS = 1 in 297 patients (28.6 %), and mGPS = 2 in 94 patients (9.1%).In our study cohort, subjects with an mGPS equal to 2 had a significantly shorter median RFS compared with subjects with mGPS equal to 1 (16 vs 19 months, hazard ratio [HR] 1.54, 95% CI 1.31–1.81, P < 0.001) or with subjects with mGPS equal to 0 (16 vs 29 months, HR 2.38, 95% CI 1.86–3.05, P < 0.001). The association between mGPS and RFS was confirmed by weighted multivariate Cox model. Although in univariate analysis higher mGPS was associated with lower OS and CSS, this association disappeared in multivariate analysis where only the presence of lymph node-positive bladder cancer and T4 stage were predictors of worse prognosis for OS and CSS.In conclusion, the mGPS is an easily measured and inexpensive prognostic marker that was significantly associated with RFS in UBC patients.

P75 Prognostic Implications Of The Modified Glasgow Prognostic Score In Early Stage Non-small Cell Lung Cancer

Introduction and objectives Up to 50% of patients treated radically for non-small cell lung cancer (NSCLC) subsequently present with metastatic disease. This is despite rigorous case-selection and the use of adjuvant therapies based on clinical and/or surgical staging. A simple, objective biomarker that identified patients at higher risk of recurrence might facilitate more effective multi-modality radical treatment. Since inflammation-based biomarkers offer robust prognostication in metastatic NSCLC, we hypothesised that the modified Glasgow Prognostic Score (mGPS), Neutrophil:Lymphocyte Ratio (NLR) and/or Platelet:Lymphocyte Ratio (PLR), measured prior to radical treatment would have utility in this regard. Methods Utilising a radiology database, we retrospectively identified all patients with Stage I-IIIa NSCLC who underwent radical treatment between August 2011 and August 2012. Electronic records were reviewed and baseline parameters, including blood results were recorded. mGPS (based on CRP and Albumin), NLR and PLR were calculated. All cases were subject to multidisciplinary assessment, detailed staging and 2-year follow-up. Kaplan-Meier plots were generated for mGPS, NLR, PLR and compared using log-rank for trend and log rank. Differences in mortality were quantified using Hazard Ratios (HR). Differences in stage proportion were compared using the Chi-Square z test. Results 97 patients were identified. 44/97 (45%) were male, mean age 70 (± 8) years. 54/97 (56%) underwent surgery, 43/97 (44%) underwent radical RT. NLR and PLR provided no useful prognostic information. In surgical patients only, increasing mGPS was associated with decreasing 2-year survival (see Figure 1(a)), with curve separation occurring 1 year post-resection. Pre-operative mGPS 1 and 2 were associated with HR for death of 3.9 (95% CI 0.8–39.5, p = 0.095) and 5.8 (95% CI 1.38–106, p = 0.02) relative to mGPS 0. There were less Stage I and more Stage II patients in the mGPS 1 group (see Figure 1(b)), mGPS 0 and 2 appeared well matched for stage. Conclusion These data suggest that pre-operative mGPS may be useful in risk-stratifying patients with early stage NSCLC. The late survival curve separation observed suggests recurrent malignancy rather than post-operative complications are likely to explain this. If confirmed prospectively, integration of mGPS into staging algorithms might allow more effective targeting of adjuvant therapies.

The Modified Glasgow Prognostic Score as a Predictor of Survival After Hepatectomy for Colorectal Liver Metastases

Background The inflammation-based Glasgow prognostic score (GPS) has been demonstrated to be prognostic for various tumors. We investigated the value of the modified GPS (mGPS) for the prognosis of patients undergoing curative resection for colorectal liver metastases (CRLM).MethodsA total of 343 patients were enrolled onto this study. The mGPS was calculated as follows: mGPS-0, C-reactive protein (CRP) ≤10 mg/L; mGPS-1, CRP >10 mg/L and albumin ≥35 g/L; and mGPS-2, CRP >10 mg/L and albumin <35 g/L. Prognostic significance was retrospectively analyzed by univariate and multivariate analyses.ResultsOf the 343 patients, 295 (86.0 %) were assigned to mGPS-0, 33 (9.6 %) to mGPS-1, and 15 (4.4 %) to mGPS-2. The median disease-free survival of patients with mGPS-0, -1, and -2 was 18.3, 15.5, and 5.2 months, respectively. The median cancer-specific survival (CSS) of patients with mGPS-0, -1, and -2 was 89.5, 62.2, and 25.8 months, respectively. The CSS of patients with mGPS-0 was significantly longer than that of patients with mGPS-2. Multivariate analysis revealed a significant association between cancer-related postoperative mortality and mGPS and carcinoembryonic antigen level.ConclusionsThe preoperative mGPS is a useful prognostic factor for postoperative survival in patients undergoing curative resection for CRLM.

Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer

The Glasgow prognostic score (GPS) is a preoperatively determined inflammation-based score. Reports suggest a significant correlation between the GPS and prognosis in several cancer types. We aimed to clarify the prognostic significance of the modified GPS (mGPS) in patients undergoing gastrectomy for gastric cancer. Two hundred and ninety-four patients with gastric cancer, 195 aged < 75 years (group NE) and 99 aged > 75 years (group E), who underwent gastrectomy from March 2005 to March 2011 were enrolled. Patients with an elevated C-reactive protein level (> 0.5 mg/dL) and hypoalbuminemia (< 3.8 g/dL) were assigned a mGPS of 2, those with either 1 abnormality were assigned a mGPS of 1, and those with neither abnormality were assigned a mGPS of 0. Cox proportional hazard models and Kaplan-Meier analysis were used to evaluate the usefulness of mGPS as a prognostic indicator. In the NE group, the prognosis of the 3 groups stratified by mGPS did not differ significantly. In multivariate Cox regression analysis, the type of gastrectomy, peritoneal metastasis, and stage were independently associated with poor prognosis. However, group E patients with a mGPS of 2 had significantly poorer prognosis than those with a mGPS of 0 or 1. In this age group, stage and mGPS were independently associated with poor prognosis. In patients aged > 75 years undergoing potentially curative gastrectomy, the preoperative mGPS was an independent predictor of survival. Therefore, mGPS can be a useful prognostic indicator in elderly patients with gastric cancer.

Comparison of the prognostic value of longitudinal measurements of systemic inflammation in patients undergoing curative resection of colorectal cancer

Background:The systemic inflammation-based prognostic scores, modified Glasgow Prognostic Score (mGPS) and the neutrophil-lymphocyte ratio (NLR) are now recognised to be useful in predicting survival in a variety of solid organ malignancies, including colorectal cancer (CRC) before treatment. However, there would appear to have been no direct comparison of these longitudinal measurements of systemic inflammation. Therefore, the aim of the present study was to compare the prognostic value of longitudinal measures of systemic inflammation, the mGPS and NLR in patients undergoing potentially curative resection for CRC.Methods:Three hundred and twenty-six patients underwent potentially curative resection for CRC between 2006 and 2010. Full biochemical and haematological data both pre- and post-operatively (3–6 months) were available for 206 patients.Results:In 206 patients, there was no significant overall change in either the mGPS or the NLR, from pre- to post-operatively. On univariate survival analysis, T-stage (P<0.001), tumour, node, metastasis stage (P<0.005), pre-operative mGPS (P<0.05), pre-operative NLR (<0.05), post-operative mGPS (P<0.001) and post-operative NLR (P<0.005) were associated with cancer-specific survival. On multivariate survival analysis, comparing pre-operative mGPS and NLR, both pre-operative mGPS and NLR were independently associated with reduced cancer-specific survival (mGPS hazard ratio (HR) 1.97, CI 1.16–3.34, P<0.05, and NLR HR 3.07, CI 1.23–7.63, P<0.05). When the same multivariate comparison was carried out on post-operative data, only the post-operative mGPS was independently associated with cancer-specific survival (HR 4.81, CI 2.13–10.83, P<0.001).Conclusion:The results of the present study support the longitudinal assessment of the systemic inflammatory response, in particular the mGPS, in patients undergoing potentially curative resection for CRC.

Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer

Background:The inflammation-based Glasgow prognostic score (GPS) has been shown to be a prognostic factor for a variety of tumours. This study investigates the significance of the modified GPS (mGPS) for the prognosis of patients with gastric cancer.Methods:The mGPS (0=C-reactive protein (CRP)⩽10 mg l−1, 1=CRP>10 mg l−1 and 2=CRP>10 mg l−1 and albumin<35 g l−1) was calculated on the basis of preoperative data for 1710 patients with gastric cancer who underwent surgery between January 2000 and December 2007. Patients were given an mGPS of 0, 1 or 2. The prognostic significance was analysed by univariate and multivariate analyses.Results:Increased mGPS was associated with male patient, old age, low body mass index, increased white cell count and neutrophils, elevated carcinoembryonic antigen and CA19-9 and advanced tumour stage. Kaplan–Meier analysis and log-rank test revealed that a higher mGPS predicted a higher risk of postoperative mortality in both relative early-stage (stage I; P<0.001) and advanced-stage cancer (stage II, III and IV; P<0.001). Multivariate analysis demonstrated the mGPS to be a risk factor for postoperative mortality (odds ratio 1.845; 95% confidence interval 1.184–2.875; P=0.007).Conclusion:The preoperative mGPS is a simple and useful prognostic factor for postoperative survival in patients with gastric cancer.

Clinical utility of the preoperative Glasgow prognostic score in patients undergoing potentially curative resection for colorectal cancer.

3611 Background: There is now good evidence that, in addition to TNM stage, the pre-operative combination of the standardised measurements of C-reactive protein and albumin, the Glasgow Prognostic Score (mGPS) provides valuable prognostic information. The aim of the present study was to examine the clinical application of the pre-operative mGPS in a large mature cohort of patients undergoing potentially curative resection for colorectal cancer. Methods: From a prospectively maintained database, consecutive patients (n= 797) with histologically proven colorectal cancer who were considered to have undergone potentially curative resection between January 1997 and December 2010 in a single surgical unit at the Royal Infirmary, Glasgow were included in the study. Results: Patients with an elevated mGPS were more likely to be older (p&lt;0.001), female (p&lt;0.05), have colonic tumours (&lt;0.001), present as an emergency (p&lt;0.001), had higher TNM stage (p&lt;0.05) and more likely to die of their disease (p&lt;0.01). The median follow-up was 66 months and using 3 year cancer-specific mortality as an endpoint, the area under the receiver operator curve was 0.652 (95% CI, 0.591–0.714; p&lt;0.001) for the mGPS and 0.668 (95% CI, 0.610–0.727; p&lt;0.001) for TNM stage. The cancer-specific survival, at 3 years, varied between 86% and 64% according to the mGPS and between 88% and 72% according to TNM stage. The cancer-specific survival, at 3 years, in patients with a mGPS 0 was 91% and 81% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 1 was 89% and 66% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 2 was 77% and 43% for TNM stage II and III respectively. Conclusions: The results of the present study show the clinical utility of the pre-operative mGPS in predicting cancer specific survival of potentially curative surgery for colorectal cancer.

The Glasgow Prognostic Score as a Predictor of Survival in Patients with Potentially Resectable Pancreatic Adenocarcinoma

Survival rates after resection of pancreatic adenocarcinoma are poor; however, several tumor-related prognostic factors have been identified. There is increasing evidence that additional patient-related prognostic factors, such as ongoing systemic inflammatory response, are associated with poor outcomes in patients with common solid tumors. The purpose of this study was to evaluate the prognostic significance of the modified glasgow prognostic score (mGPS) in resected pancreatic ductal adenocarcinoma. Data were collected from 101 patients who had undergone pancreatic resection for ductal adenocarcinoma. Tumor and host factors were analyzed by Kaplan-Meier and Cox proportional hazard models to evaluate their potential prognostic effects. An elevated mGPS was associated with lower overall survival rate after pancreatic resection. The median actuarial survival rate for patients with an mGPS of 0, 1, or 2 was 37.2, 11.5, and 7.3, respectively (p = 0.0001). The Cox proportional hazards model, including all the parameters statistically significant at univariate analysis, demonstrated that mGPS, lymph node ratio (LNR), and positive resection margins were independent negative prognostic factors Margin involvement, LNR, and the preoperative mGPS were identified as independent predictors of survival in patients undergoing potentially curative pancreatic resection. Based on the present results and existing validation literature, the mGPS should be included in the routine assessment of patients with pancreatic cancer to better stratify patients for entry into therapeutic trials.

A Prospective Comparison of the Prognostic Value of Tumor- and Patient-Related Factors in Patients Undergoing Potentially Curative Surgery for Pancreatic Ductal Adenocarcinoma

Outcome prediction after resection with curative intent for pancreatic ductal adenocarcinoma remains a challenge. There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients undergoing resection for a variety of common solid tumors. Our aim was to prospectively evaluate the prognostic value of tumor- and patient-related factors including the systemic inflammatory response in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma of the head of pancreas. The prognostic impact of tumor factors such as stage and host factors, including the systemic inflammatory response (modified Glasgow Prognostic Score [mGPS]), were evaluated in a prospective study of 135 patients who underwent elective pancreaticoduodenectomy for pancreatic ductal adenocarcinoma from January 2002 to April 2009. In addition to the established tumor-related pathological factors (in particular margin involvement; hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.65-4.84, P < 0.001), an elevated mGPS (HR 2.26, 95% CI 1.43-3.57, P < 0.001) was independently associated with lower overall survival after pancreaticoduodenectomy. Additionally, in an adjuvant therapy subgroup of 74 patients, both margin involvement and an elevated mGPS remained independently associated with reduced overall survival. We have prospectively validated the influence of tumor-related and patient-related factors. Margin involvement and the preoperative mGPS were the most important determinants of overall survival in patients undergoing potentially curative pancreaticoduodenectomy. Furthermore, both had independent prognostic value in those patients receiving adjuvant chemotherapy. In the future, this may be considered a stratification factor for entry onto therapeutic trials.

Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer

Recent studies have revealed the Glasgow prognostic score (GPS) to aid in the prediction of postoperative outcome in colorectal cancer patients. However, whether GPS predicts poor prognosis in curative colorectal cancer patients has yet to be ascertained. Furthermore, there is no information on the association between GPS and adjuvant chemotherapy in stage II or III colorectal cancer patients. A total of 219 patients with stage II and III colorectal cancer were included in this trial. The modified GPS (mGPS) defined in this study was calculated on the basis of admission data as follows: patients with an elevated level of both C-reactive protein (0.5 mg/dl) and hypoalbuminemia (Alb <3.5 mg/dl) were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. The association between the mGPS and clinicopathological findings and survival was retrospectively assessed. The mGPS was significantly higher in patients with an advanced age, serosal invasion, advanced stage cancer and pre-operative high CEA levels. Kaplan-Meier analysis revealed that a higher GPS predicted a higher risk of postoperative mortality in stage II and/or III colorectal cancer patients. Multivariate analyses revealed that the mGPS was the most sensitive predictor of postoperative mortality in stage II/III or stage II, respectively. The prognosis of stage II patients with a higher mGPS was as favorable as that of patients with a lower mGPS when adjuvant chemotherapy was undertaken. Pre-operative mGPS is considered to be a useful predictor of postoperative mortality in patients with stage II and/or III colorectal cancer, independently of the CEA test or TNM system. Postoperative adjuvant chemotherapy may be recommended for stage II colorectal cancer patients with a high mGPS.

Comparison of the prognostic value of tumour‐ and patient‐related factors in patients undergoing potentially curative surgery for colon cancer

To comprehensively compare the prognostic value of tumour- and patient-related factors in patients undergoing curative surgery for colon cancer. From a database of 287 patients who underwent elective resection between 1997 and 2005, tumour factors including stage and host factors including systemic inflammatory response [modified Glasgow Prognostic Score (mGPS)] were identified. Median follow-up was 65 months. Over this period, 125 patients died, 80 from cancer. On multivariate analysis of all significant patient and tumour related factors, Dukes stage (P < 0.01), vascular invasion (P < 0.01) and the mGPS (P < 0.01) were independently associated with cancer-survival. Of the patient-related factors, age (P < 0.01), haemoglobin (P < 0.01), white-cell (P < 0.01), neutrophil (P < 0.01) and platelet (P < 0.01) counts, and alkaline phosphatase (P < 0.01) were most significantly associated with the mGPS. In addition to tumour-related factors such as Dukes stage and vascular invasion, the preoperative mGPS should be included to guide prognosis in patients undergoing curative resection for colon cancer.

Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer

The presence of systemic inflammation before surgery, as evidenced by the glasgow prognostic score (mGPS), predicts poor long-term survival in colorectal cancer. The aim was to examine the relationship between the preoperative mGPS and the development of postoperative complications in patients undergoing potentially curative resection for colorectal cancer. Patients (n=455) who underwent potentially curative resections between 2003 and 2007 were assessed consecutively, and details were recorded in a database. The majority of patients presented for elective surgery (85%) were over the age of 65 years (70%), were male (58%), were deprived (53%), and had TNM stage I/II disease (61%), had preoperative haemoglobin (56%), white cell count (87%) and mGPS 0 (58%) in the normal range. After surgery, 86 (19%) patients developed a postoperative complication; 70 (81%) of which were infectious complications. On multivariate analysis, peritoneal soiling (P<0.01), elevated preoperative white cell count (P<0.05) and mGPS (P<0.01) were independently associated with increased risk of developing a postoperative infection. In elective patients, only the mGPS (OR=1.75, 95% CI=1.17–2.63, P=0.007) was significantly associated with increased risk of developing a postoperative infection. Preoperative elevated mGPS predicts increased postoperative infectious complications in patients undergoing potentially curative resection for colorectal cancer.