Association of modified Glasgow Prognostic Score (mGPS) with survival outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (CPI).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 738-738
Author(s):  
Jacqueline T Brown ◽  
Yuan Liu ◽  
Dylan J. Martini ◽  
Julie M. Shabto ◽  
Elise Hitron ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Progression Free Survival ◽  
Summary Score ◽  
Risk Models ◽  
Reactive Protein ◽  
Modified Glasgow Prognostic Score ◽  
Cox Proportional Hazard

738 Background: The current risk models for mRCC were developed for patients treated with targeted therapy. The mGPS incorporates albumin and C-reactive protein and may serve as a composite prognostic biomarker in mRCC in the era of CPI. Methods: We conducted a retrospective analysis of patients with mRCC treated with CPI (anti-PD1 or PD-L1 agents) at Winship Cancer Institute between 2015-2018. Overall survival (OS) and progression-free survival (PFS) were defined as months from CPI initiation to death or clinical/radiographic progression, respectively. mGPS was defined as a summary score with one point given for CRP > 10 mg/L and/or albumin < 3.5 g/dL. Univariate (UVA) and multivariate (MVA) analyses were carried out for OS and PFS using Cox proportional hazard model. Results: A total of 78 eligible patients were included with a median follow up of 30.7 months. Median age was 66 years (range = 38-82), 64% were male, 78% had clear cell histology, and 76% received anti-PD-1 monotherapy. Higher mGPS at baseline was significantly associated with worse OS while at week 6 was associated with worse OS and PFS (Table). Conclusions: A higher mGPS score in the early course of CPI treatment was associated with worse survival in patients with mRCC. These results should be validated in a larger, prospective study.[Table: see text]

Baseline modified Glasgow prognostic score (mGPS) in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICI).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16546-e16546
Author(s):  
Jacqueline T Brown ◽  
Yuan Liu ◽  
Dylan J. Martini ◽  
Julie M. Shabto ◽  
Greta Russler ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Checkpoint Inhibitors ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Progression Free Survival ◽  
Experimental Therapy ◽  
Modified Glasgow Prognostic Score ◽  
Kaplan Meier ◽  
Treatment Paradigm ◽  
Line Of Therapy

e16546 Background: The IMDC and MSKCC risk models for mRCC were validated before the era of ICI. The mGPS incorporates albumin and C-reactive protein and reflects systemic inflammation. mGPS may be a useful prognostic biomarker of particular relevance in mRCC given the current, largely ICI-based treatment paradigm and hypothesis that systemic inflammation may contribute to ICI resistance. Methods: We retrospectively assessed mRCC patients treated with ICI (including anti-PD-1 and anti-PD-L1 agents) in any line of therapy at Winship Cancer Institute of Emory University from 2015-2018. Primary outcomes assessed included overall survival (OS) and progression-free survival (PFS). mGPS was calculated by giving 1 point for CRP > 10 mg/L and/or albumin < 3.5 g/dL with 0 points awarded for solitary low albumin. The relationship between mGPS and survival outcomes was assessed in UVA and MVA using Cox proportional hazard model and in Kaplan-Meier analysis. Results: We assessed 156 eligible patients. Median follow up was 24.2 months. Median age was 64 years, 69% were male, 20% were Black, and 78% had clear cell histology. 57.1% received anti-PD-1 monotherapy whereas all others received dual ICI or ICI combined with an antiangiogenic agent or experimental therapy in trial. Higher baseline mGPS was significantly associated with worse OS and PFS (Table). The median OS of patients with baseline mGPS of 0, 1 and 2 was 44.5 (CI 27.3, NA), 15.3 (CI 11, 24.2) and 10 (CI 4.6, 17.5) months, respectively (p<0.0001), while the median PFS of these three cohorts was 6.7 (CI 3.6, 13.1), 4.2 (CI 2.9, 6.2) and 2.6 (CI 2, 5.6) months, respectively (p=0.0216). Conclusions: A higher mGPS at the start of therapy was negatively prognostic in patients with mRCC receiving ICI. These results should be validated in a larger, prospective study. [Table: see text]

Association of baseline modified Glasgow Prognostic Score (mGPS) with survival outcomes in patients with metastatic urothelial cell carcinoma (mUCC) treated with immune checkpoint inhibitors (CPI).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 563-563
Author(s):  
Jacqueline T Brown ◽  
Yuan Liu ◽  
Julie M. Shabto ◽  
Dylan J. Martini ◽  
Deepak Ravindranathan ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Pearson Correlation ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Progression Free Survival ◽  
Summary Score ◽  
Survival Outcomes ◽  
Clinical Tool ◽  
Lymphocyte Ratio ◽  
The Impact

563 Background: The mGPS, a clinical tool that incorporates albumin and C-reactive protein, has proven useful in the prognostication of multiple cancers. Several CPI agents have been approved for the treatment of mUCC but a prognostic biomarker is needed. We investigated the impact of mGPS on survival outcomes in mUCC patients receiving CPI. Methods: We retrospectively reviewed mUCC patients treated with CPI (PD-1 or PD-L1 inhibitors) at Winship Cancer Institute from 2015 to 2018. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of CPI until death or clinical/radiographic progression, respectively. mGPS was defined as a summary score with one point given for CRP > 10 mg/L and/or albumin < 3.5 g/dL. Univariate (UVA) and multivariate (MVA) analyses were carried out using Cox proportional hazard model for OS and PFS. Results: A total of 53 patients were included with a median follow up 27.1 months. The median age was 70 years with 84.9% male and 20.8% black. Baseline mGPS was 0 in 43.4%, 1 in 28.3% and 2 in 28.3%. The correlation between mGPS and other inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR), was high with Pearson correlation coefficients ≥ 0.48 (p ≤ 0.0003). Increased mGPS at the time of CPI initiation was associated with poorer OS and PFS (Table). Conclusions: The mGPS may be a useful prognostic tool in mUCC patients when treatment with CPI is under consideration. These results warrant a larger study for validation.[Table: see text]

scholarly journals Modified Glasgow Prognostic Score associated with survival in metastatic renal cell carcinoma treated with immune checkpoint inhibitors

2021 ◽  
Vol 9 (7) ◽  
pp. e002851
Author(s):  
Jacqueline T Brown ◽  
Yuan Liu ◽  
Julie M Shabto ◽  
Dylan Martini ◽  
Deepak Ravindranathan ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Immune Checkpoint ◽  
Renal Cell ◽  
Checkpoint Inhibitors ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Glasgow Prognostic Score ◽  
Modified Glasgow Prognostic Score

BackgroundThe modified Glasgow Prognostic Score (mGPS) is a composite biomarker that uses albumin and C reactive protein (CRP). There are multiple immune checkpoint inhibitor (ICI)-based combinations approved for metastatic renal cell carcinoma (mRCC). We investigated the ability of mGPS to predict outcomes in patients with mRCC receiving ICI.MethodsWe retrospectively reviewed patients with mRCC treated with ICI as monotherapy or in combination at Winship Cancer Institute between 2015 and 2020. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of ICI until death or clinical/radiographical progression, respectively. The baseline mGPS was defined as a summary score based on pre-ICI values with one point given for CRP>10 mg/L and/or albumin<3.5 g/dL, resulting in possible scores of 0, 1 and 2. If only albumin was low with a normal CRP, no points were awarded. Univariate analysis (UVA) and multivariate analysis (MVA) were carried out using Cox proportional hazard model. Outcomes were also assessed by Kaplan-Meier analysis.Results156 patients were included with a median follow-up 24.2 months. The median age was 64 years and 78% had clear cell histology. Baseline mGPS was 0 in 36%, 1 in 40% and 2 in 24% of patients. In UVA, a baseline mGPS of 2 was associated with shorter OS (HR 4.29, 95% CI 2.24 to 8.24, p<0.001) and PFS (HR 1.90, 95% CI 1.20 to 3.01, p=0.006) relative to a score of 0; this disparity in outcome based on baseline mGPS persisted in MVA. The respective median OS of patients with baseline mGPS of 0, 1 and 2 was 44.5 (95% CI 27.3 to not evaluable), 15.3 (95% CI 11.0 to 24.2) and 10 (95% CI 4.6 to 17.5) months (p<0.0001). The median PFS of these three cohorts was 6.7 (95% CI 3.6 to 13.1), 4.2 (95% CI 2.9 to 6.2) and 2.6 (95% CI 2.0 to 5.6), respectively (p=0.0216). The discrimination power of baseline mGPS to predict survival outcomes was comparable to the IMDC risk score based on Uno’s c-statistic (OS: 0.6312 vs 0.6102, PFS: 0.5752 vs 0.5533).ConclusionThe mGPS is prognostic in this cohort of patients with mRCC treated with ICI as monotherapy or in combination. These results warrant external and prospective validation.

Baseline neutrophil-to-eosinophil ratio (NER) and its association with clinical outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (CPI).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16569-e16569
Author(s):  
Deepak Ravindranathan ◽  
Yuan Liu ◽  
Dylan J. Martini ◽  
Jacqueline T Brown ◽  
Bassel Nazha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Benefit ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
P Value ◽  
Proportional Hazard ◽  
Free Survival ◽  
Cox Proportional Hazard ◽  
Significant Difference

e16569 Background: Inflammatory markers have been studied as prognostic markers in patients with mRCC treated with CPIs. Recently, eosinophilia has been found to be associated with improved survival of patients with melanoma treated with CPIs. We reported baseline NER in patients with mRCC treated with CPIs and its association with clinical outcomes. Methods: We conducted a retrospective analysis of patients with mRCC treated with CPIs at Winship Cancer Institute from 2015-2018. Clinical outcomes were measured as overall survival (OS), progression-free survival (PFS), and clinical benefit (CB). OS and PFS were calculated from CPI-initiation to date of death and radiographic or clinical progression, respectively. Patients with baseline NER were categorized into high or low; high defined as NER > 49.2 and low defined as NER < 49.2. Univariate (UVA) and multivariate (MVA) analyses were carried out for OS and PFS using Cox proportional hazard model. Results: A total of 184 patients were studied with a median follow up of 25.4 months. Median age was 63 years old with 72% male and 20% black. About 25% were in high NER group. The high NER patients had significantly shorter OS in both UVA (HR: 0.58, p-value=0.017) and MVA (HR: 0.62, p-value=0.046) (Table). There was no significant difference between groups for PFS. Clinical benefit was seen in 47.3% of patients with low baseline NER and 40% with high NER. Conclusions: High baseline NER was associated with worse OS in patients with mRCC treated with CPIs. Larger, prospective studies are warranted to validate this hypothesis generating data.[Table: see text]

scholarly journals The Inflammation-Based Glasgow Prognostic Score as a Prognostic Factor in Patients with Intensive Cardiovascular Care Unit

Medicina ◽  
2019 ◽  
Vol 55 (5) ◽  
pp. 139 ◽  
Author(s):  
Servet Altay ◽  
Muhammet Gürdoğan ◽  
Muhammed Keskin ◽  
Fatih Kardaş ◽  
Burcu Çakır
Keyword(s):  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Albumin Level ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Independent Association ◽  
One Year ◽  
The Glasgow Prognostic Score ◽  
Cardiovascular Care

Background: The Glasgow prognostic score (GPS), which is obtained from a combination of C-reactive protein (CRP) and serum albumin level, predicts poor prognoses in many cancer types. Systemic inflammation also plays an important role in pathogenesis of cardiovascular diseases. In this study, we aimed to investigate the effect of inflammation-based GPS on in-hospital and long-term outcomes in patients hospitalized in intensive cardiovascular care unit (ICCU). Methods: A total of 1004 consecutive patients admitted to ICCU were included in the study, and patients were divided into three groups based on albumin and CRP values as GPS 0, 1, and 2. Patients’ demographic, clinic, and laboratory findings were recorded. In-hospital and one-year mortality rates were compared between groups. Results: Mortality occurred in 109 (10.8%) patients in in-hospital period, 82 (8.1%) patients during follow-up period, and thus, cumulative mortality occurred in 191 (19.0%) patients. Patients with a high GPS score had a higher rate of comorbidities and represented increased inflammatory evidence. In the multivariate regression model there was independent association with in-hospital mortality in GPS 1 patients compared to GPS 0 patients (Odds ratio, (OR); 5.52, 95% CI: 1.2–16.91, p = 0.025) and in GPS 2 patients compared to GPS 0 patients (OR; 7.01, 95% CI: 1.39–35.15, p = 0.018). A higher GPS score was also associated with a prolonged ICCU and hospital stay, and increased re-hospitalization in the follow-up period. Conclusion: Inflammation based GPS is a practical tool in the prediction of worse prognosis both in in-hospital and one-year follow-up periods in ICCU patients.

Modified Glasgow Prognostic Score (mGPS) for Prognostication of Adult Oncology Patients With Palliative Intent in a Regional Victorian Hospital, Australia

2020 ◽  
pp. 104990912095838
Author(s):  
Nuttaradee Lojanapiwat ◽  
Md Rafiqul Islam ◽  
Martin Ridout ◽  
Sivakumar Subramaniam
Keyword(s):  
Cancer Patients ◽  
Median Survival ◽  
Cox Regression ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
P Value ◽  
C Reactive Protein ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Modified Glasgow Prognostic Score

Background: Accurate prognostication is essential in caring for palliative patients. Various prognostication tools have been validated in many settings in the past few years. Biomarkers of inflammation (albumin and C-reactive protein) are combined to calculate the modified Glasgow prognostic score (mGPS), which has been found to be a simple prognostic tool in this population. Objective: This retrospective cohort study was to evaluate mGPS as a prognostication tool for cancer patients admitted to an acute hospital in regional Australia. Methods: Adult cancer patients admitted to an acute Australian regional hospital during 2017 who had albumin and C-reactive protein (CRP) tested were included. The mGPS was calculated based on their admission values and discharge values. Based on their score (0-2), groups were compared using univariate and multivariate Cox regression analysis for prognostication. Kaplan-Meier survival plots and median survival time from admission and discharge were constructed. Results: A total of 170 patient records were reviewed of which 95 had admission and discharge mGPS scores available for analysis. Of those, 86 had died at the time of data analysis. The median survival for admission mGPS 0, 1, 2 was 168,156 and 74 days. For discharge mGPS 0, 1, 2 medians were 168,119 and 70 days. On multi variate analysis admission mGPS 2 showed Hazard ratio of 2.29 (95% CI 1.16-4.56, p -0.02) and discharge mGPS 2 of 2.07 (95% CI 0.95-4.50, p value 0.07). Conclusions: In this study, mGPS was able to differentiate cancer patients into various prognostic groups. Further studies in regional acute hospitals could validate this prospectively with a multi-center larger sample size.

scholarly journals Clinical Impact of Combined Modified Glasgow Prognostic Score and C-Reactive Protein/Albumin Ratio in Patients with Colorectal Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 859
Author(s):  
Woosung Son ◽  
Su-Jin Shin ◽  
Su Hyeong Park ◽  
Soo Kyung Lee ◽  
Eun Jung Park ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Score ◽  
Area Under The Curve ◽  
Glasgow Prognostic Score ◽  
Mean Difference ◽  
Prognostic Impact ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Modified Glasgow Prognostic Score

The prognostic impact of the combination of the modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin ratio (CAR) in colorectal cancer (CRC) is unclear. We aimed to investigate the clinical usefulness of this combination as a predictor of survival in CRC patients. We retrospectively evaluated 769 CRC patients who had undergone surgery between January 2006 and March 2014. The CAR and mGPS within 1 month postoperation were examined. The integrated area under the curve (iAUC) was compared among mGPS, CAR, and the combined classification (CC). The optimal CAR cut-off for discriminating overall survival was 0.14. Based on this cut-off, the mGPS 0 group was divided into the mGPS 0 with low CAR and the mGPS 0 with high CAR groups, whereas all mGPS 1 and 2 patients were classified into the high CAR group. CC was an independent prognostic factor, and its iAUC value (0.587, 95% CI 0.553–0.624) was superior to those of the mGPS (0.544, 95% CI 0.516–0.576) (bootstrap iAUC mean difference = 0.043; 95% CI = 0.015–0.072) and CAR (0.578, 95% CI 0.545–0.613) (bootstrap iAUC mean difference = 0.009; 95% CI = 0.002–0.017), respectively. In conclusion, the combination of mGPS and CAR has a synergistic effect and has a higher prognostic accuracy than mGPS or CAR alone in patients with CRC.

MO605INFLAMMATION-BASED MODIFIED GLASGOW PROGNOSTIC SCORE AND CHRONIC KIDNEY DISEASE PROGRESSION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gabriel Stefan ◽  
Simona Stancu ◽  
Adrian Dorin Zugravu ◽  
Cristina-Stela Capusa
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Rapid Progression ◽  
Ckd Progression ◽  
Loss To Follow Up ◽  
Reactive Protein ◽  
Modified Glasgow Prognostic Score ◽  
End Stage

Abstract Background and Aims The modified Glasgow prognostic score (mGPS), based on combination between albumin (sAlb) and C-reactive protein (CRP), has been derived from oncology and validated in multiple diseases. Since chronic kidney disease (CKD) progression is related to inflammation, we aimed to evaluate the relationship between the mGPS and CKD outcome. Method The present retrospective unicentric cohort study included 547 CKD patients (age 60.2 years, 53% male, eGFR 42.0 mL/min, mean change -2 mL/min/year) admitted between January 1, 2007 and December 31, 2012. The mGPS assessment: zero points if CRP ≤10 mg/L and sAlb ≥3.5 g/dL; one point if CRP &gt;10 mg/L and sAlb ≥3.5 g/dL, two points if CRP &gt;10 mg/L and sAlb &lt;3.5 g/dL. Patients records were reviewed from the CKD diagnosis to one of the four outcomes: end-stage kidney disease (ESKD), death, loss to follow-up, or until July 31, 2017. Results The mGPS score was 0 for 420 (78%), 1 for 110 (19%), and 2 for 17 (3%) patients. Rapid progression defined as a sustained decline in eGFR of more than 5 mL/min/year was found in 17% of the studied patients. More patients with rapid CKD progression were found in the group with the highest mGPS (30% vs 17%, vs 16%, p=0.05). In the multivariate analysis, mGPS was associated with the eGFR slope (OR 1.42 (95%CI 0.29, 2.55), p 0.01). Moreover, mGPS was negatively correlated with baseline eGFR (OR -3.74 (95%CI 7.8, 0.33), p 0.05) and positively with albuminuria (0.87 (95%CI 0.51, 1.23), p 0.001). During the study period, 130 patients (24%) died and 109 (20%) reached ESKD. The mean kidney survival time was 8.1 (95%CI 7.9, 8.4) years. Kidney survivals at 12, 24, 36, 48, 60, and 72 months were 96, 95, 89, 86, 83 and 82%, respectively. In univariate time-dependent analysis, patients with zero mGPS had better kidney survival than those with the score of one and two (99.9 (95%CI 96.9, 102.9) vs 92.1 (95%CI 85.2, 99.0) vs 78.1 (95%CI 60.4, 95.4) months, log rank p=0.02). However, the kidney survival differences were not present after adjusting for CKD progression risk factors (HR 1.12 (95%CI 0.78, 1.62), p 0.5). Conclusion The inflammation-based mGPS score was associated with eGFR decline in CKD patients. Therefore, could prove useful in improving risk stratification of CKD patients.

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