scholarly journals Prognostic Value of Routinely Measured Inflammatory Biomarkers in Older Cancer Patients: Pooled Analysis of Three Cohorts

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6154
Author(s):  
Nadia Oubaya ◽  
Pierre Soubeyran ◽  
Nicoleta Reinald ◽  
Marianne Fonck ◽  
Mylène Allain ◽  
...  

Background: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers. Methods: A pooled analysis of prospective multicenter cohorts of cancer patients aged ≥70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP ≤ 10 mg/L, albumin ≥ 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell’s C index (C) and net reclassification improvement (NRI). Results: Overall, 1800 patients were analyzed (mean age: 79 ± 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03–9.89] for GPS1, 11.64 [4.54–29.81] for GPS2, and 7.15 [3.22–15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79–3.34] for GPS1, 3.97 [2.93–5.37] for GPS2, and 2.81 [2.17–3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80–0.83]) was increased by adding GPS (C = 0.84 [0.82–0.85]; NRI events (NRI+) = 10% [2–16]) and CRP/albumin ratio (C = 0.83 [0.82–0.85]; NRI+ = 14% [2–17]). Conclusions: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 295-295
Author(s):  
Yusuke Shimodaira ◽  
Sachie Koike ◽  
Yusuke Takahashi ◽  
Masao Okada ◽  
Kaori Hayashibara ◽  
...  

295 Background: Several biomarkers based on serum chemistry have been reported to be associated with the prognosis of several types of cancers. This retrospective study aimed to investigate the prognostic value of preoperative mGPS and NLR after curative resection for gastric cancer. Methods: A total of 295 patients who underwent curative gastrectomy for primary gastric cancer at our institution from January 2013 to December 2017 were enrolled in this study. The mGPS was calculated by CRP and Alb using standard thresholds ( > 0.5 mg/dL for CRP and < 3.5 g/dL for Alb). The NLR was defined as absolute neutrophil count divided by absolute lymphocyte count. The survival curves of patients stratified by each parameter were plotted by the Kaplan-Meier method and compared by log-rank test. Multivariate Cox proportional hazards regression models were used to select parameters independently correlated with prognosis. Results: The median follow-up time was 36.7 months, and 29 patients died during follow-up. The estimated 5-year survival rate was 83.1%. Results from the univariate analyses showed mGPS2 (CRP > 0.5 mg/dL and Alb < 3.5 g/dL) was associated with poor survival while NLR and NLRc was not (P < 0.001, P = 0.506, and P = 0.423, respectively). In the multivariate analyses, the mGPS2 was identified as an independent predictive factor for OS in gastric cancer patients after curative resection (HR: 2.624; 95% CI: 1.058-6.505; P = 0.037). Conclusions: Preoperative mGPS2 was associated with worse survival after curative resection of gastric cancer patients. Based on our study, those with mPGS2 may be warranted to receive additional therapy or nutritional support to acquire better survival.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11551-11551
Author(s):  
Elena Paillaud ◽  
Pierre Soubeyran ◽  
Nadia Oubaya ◽  
Etienne Brain ◽  
Marianne Fonck ◽  
...  

11551 Background: To assess prognostic value of routine biomarkers in older patients with cancer. Methods: A pooled analysis of three prospective multicentre cohorts, ELCAPA, PHRC Aquitaine and ONCODAGE was conducted. Patients aged 70 years or older, with cancer were included. Biomarkers collected were plasmatic C-reactive protein, albumin and a combined score: Glasgow Prognostic Score (GPS). The GPS comprised three categories (0: CRP≤10 mg/L, albumin≥35 g/L; 1: CRP≤10 mg/L and albumin < 35 g/L, or CRP > 10 mg/L and albumin≥35 g/L; 2: CRP > 10 mg/L and albumin < 35 g/L).The primary endpoint was overall survival at 12 months. Multivariable Cox models were used, adjusting for age, sex, localisation, metastatic status, performance status, frailty screening index, the G8. Discriminative properties were assessed using Harrell C index and NRI (Net Reclassification Improvement). Results: Overall 1800 patients were analyzed (ELCAPA: N = 543, PHRC Aquitaine: N = 253, ONCODAGE: N = 1004; mean age: 78.5±5.5 years; 61.7% of men; 37% metastatic; most frequent localisations: breast (34.9%) and colon-rectum (17.7%); 70.7% of patients screened at risk of frailty with G8). Overall survival was 71.1%. GPS was independently associated with death (among normal G8: GPS 1: Hazard Ratio (HR) = 4.48; 95% Confidence Interval (95% CI) = [2.03; 9.89], GPS 2: 11.64 [4.54; 29.81], among abnormal G8: GPS 1: 2.45 [1.79; 3.34], GPS 2: 3.97 [2.93; 5.37]. The addition of GPS to the clinical model (Harell C: 0.82 [0.80; 0.83]) improved discrimination (Harell C: 0.84 [0.82; 0.85], NRI: 11% [5; 19]). Conclusions: GPS could be used in older patients with cancer to help decision-making and prognosis assessment.


2017 ◽  
Vol 33 (2) ◽  
pp. 201-207 ◽  
Author(s):  
Jing Jin ◽  
Kejia Hu ◽  
Yongzhao Zhou ◽  
Weimin Li

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.


2020 ◽  
Author(s):  
Huan Zhang ◽  
Dianyun Ren ◽  
Xin Jin ◽  
Heshui Wu

Abstract Background: Several studies were conducted to explore the prognostic value of modified Glasgow Prognostic Score (mGPS) in pancreatic cancer, which reported contradictory results. The purpose of this meta-analysis was to summarize the prognostic value of mGPS in pancreatic cancer by investigating the correlation between mGPS and overall survival (OS). Methods: A systematic literature search was performed in PubMed, EMBASE, ISI Web of Science, Cochrane library databases and OVID to identify eligible studies published from Jan 1, 2011 to June 20, 2020. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were used to detect the prognostic significance of mGPS in patients with pancreatic cancer. Results: A total of 222 non-repetitive studies were identified, and 20 enrolled studies described the association between survival outcomes and mGPS in pancreatic cancer patients. The results showed a significant correlation between high mGPS and poor OS (HR=1.50, 95% CI=1.20–1.89, P<0.0001). Similar results were observed in the subgroup analyses of OS, which were based on the treatment regimen and research region. Conclusions: Our study suggested the close association between the poor prognosis and high level of mGPS, which will be helpful for future clinical applications in pancreatic cancer patients.


Author(s):  
Jiahui Zhou ◽  
Wene Wei ◽  
Hu Hou ◽  
Shufang Ning ◽  
Jilin Li ◽  
...  

Background: Emerging evidence suggests that inflammatory response biomarkers are predictive factors that can improve the accuracy of colorectal cancer (CRC) prognoses. We aimed to evaluate the prognostic significance of C-reactive protein (CRP), the Glasgow Prognostic Score (GPS), and the CRP-to-albumin ratio (CAR) in CRC.Methods: Overall, 307 stage I–III CRC patients and 72 colorectal liver metastases (CRLM) patients were enrolled between October 2013 and September 2019. We investigated the correlation between the pretreatment CRP, GPS, and CAR and the clinicopathological characteristics. The Cox proportional hazards model was used for univariate or multivariate analysis to assess potential prognostic factors. A receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value of each prognostic score. We established CRC survival nomograms based on the prognostic scores of inflammation.Results: The optimal cutoff levels for the CAR for overall survival (OS) in all CRC patients, stage I–III CRC patients, and CRLM patients were 0.16, 0.14, and 0.25, respectively. Kaplan–Meier analysis and log-rank tests demonstrated that patients with high CRP, CAR, and GPS had poorer OS in CRC, both in the cohorts of stage I–III patients and CRLM patients. In the different cohorts of CRC patients, the area under the ROC curve (AUC) of these three markers were all high. Multivariate analysis indicated that the location of the primary tumor, pathological differentiation, and pretreatment carcinoembryonic antigen (CEA), CRP, GPS, and CAR were independent prognostic factors for OS in stage I–III patients and that CRP, GPS, and CAR were independent prognostic factors for OS in CRLM patients. The predictors in the prediction nomograms included the pretreatment CRP, GPS, and CAR.Conclusions: CRP, GPS, and CAR have independent prognostic values in patients with CRC. Furthermore, the survival nomograms based on CRP, GPS, and CAR can provide more valuable clinical significance.


2020 ◽  
Author(s):  
Shuxin Sun ◽  
Chaobin He ◽  
Jun Wang ◽  
Xin Huang ◽  
Jiali Wu ◽  
...  

Abstract Background Growing evidence indicates that systemic inflammatory response plays an important role in cancer development and progression. Several inflammatory markers have been reported to be associated with the clinical outcomes in patients with various types of cancer. This study was designed to evaluate the prognostic value of the inflammatory indexes in patients suffering from ampullary cancer (AC) who underwent pancreaticoduodenectomy (PD). Methods We retrospectively reviewed a database of 358 patients with AC who underwent PD between 2009 and 2018. R software was used to compare the area under the time-dependent receiver operating characteristic (ROC) curves (AUROCs) of the inflammation-based indexes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI) and prognostic index (PI), in terms of their predictive value of survival. The survival differences of these indexes were compared by Kaplan-Meier method and univariate and multivariate analyses were performed to determine the prognostic factors of progress-free survival (PFS) and overall survival (OS). Results The estimated 1-, 2-, and 3-year OS and PFS rates were 83.9%, 65.8%, 55.2% and 58.0%, 42.8%, 37.8%, respectively, for the entire cohort. The survival differences were significant in terms of OS and PFS when they were stratified by these inflammation-based indexes. The comparisons of AUROCs of these inflammation-based indexes illustrated that NLR and PI displayed highest prognostic value, compared to other indexes. When NLR and PI were combined, NLR-PI showed even higher AUROC values and was identified as a significant prognostic factor in terms of OS and PFS. Conclusion Specific inflammatory indexes, such as NLR, PLR and PI, were found to be able to predict the OS or PFS of patients. As a novel inflammatory index, the level of NLR-PI, which can be regarded as a more useful prognostic index, exhibited strong predictive power for predicting prognosis of patients with AC after PD procedure.


BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhenhua Liu ◽  
Hongtai Shi ◽  
Longyun Chen

Abstract Background In recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC. Methods Studies assessing the role of pre-treatment CAR in prognosis of EC were searched from PubMed, Embase and the Cochrane Library (last update by April 16, 2019). The hazard ratios (HRs) of CAR and the corresponding 95% CIs for overall survival (OS) or cancer-specific survival (CSS) in EC were extracted for pooled analysis. Results A total of eight observational studies including 2255 patients were collected. The pooled analysis showed that high CAR was related to worse OS in EC (pooled HR = 1.81; 95% CI = 1.40–2.35; P < 0.001). Subgroup analyses showed that the negative correlation between the CAR and OS was consistently demonstrated in subgroups stratified by country, pathological type, and cut-off value (P < 0.05). However, there was no relation between CAR and OS in subgroup of patients receiving neoadjuvant chemotherapy at a proportion of 100% (HR = 1.15, 95% CI = 0.56–2.69; P = 0.715). In addition, high CAR was also related to worse CSS in EC (pooled HR = 2.61; 95% CI = 1.67–4.06; P < 0.001). Conclusions High pre-treatment CAR was an adverse prognostic factor for EC patients. More large-sample clinical trials are still needed to verify the prognostic value of pre-treatment CAR in EC.


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