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Glasgow Prognostic Score Is an Independent Prognostic Index for Perioperative and Overall Survival in Patients With Gastric Cancer and No Perioperative Treatment
Nathaniel Melling, Amica GRüNing, Matthias Reeh, Faik G. Uzunoglu, Jakob R. Izbicki, Dean Bogoevski*
General, Visceral and Thoracic Surgery, University Clinic Hamburg-Eppendorf, Hamburg, Germany
Background
Systemic inflammation (SI) has been evaluated as a key factor in tumorigenesis and cancer progression. C-reactive protein (CRP) and albumin as parameters of SI form the Glasgow Prognostic Score (GPS). The purpose of the study was to evaluate the potential prognostic role of GPS in a homogeneous population of gastric cancer (GC) patients undergoing surgical treatment only.
Methods
All patients underwent surgery between 2005 and 2012. Patients who had received any kind of neoadjuvant or adjuvant treatment or had other malignant tumors or inflammatory diseases were excluded. 88 patients met all inclusion criteria (age over 18 years, documented preoperative serum levels of albumin and CRP, histologically proven gastric cancer, gastrectomy and D2 lymphadenectomy with curative intent). CRP and albumin levels were retrieved from a prospective database to calculate GPS and correlate it with clinico-pathological characteristics and outcome.
Results
Increasing GPS was significantly linked to more aggressive tumor biology in terms of tumor size (GPS 0: 51.2% T1 and T2, 48.8% T3 and T4; GPS 1: 23.8% T1 and T2, 76.2% T3 and T4; GPS 2: 23.1% T1 and T2, 76.9% T3 and T4; p=0.026), venous vessel invasion (GPS 0: 91.2% V0, 8.8% V1; GPS 1: 66.7% V0, 33.3% V1; GPS 2: 55.0% V0, 45.0% V1; p=0.008), resection margin status (GPS 0: 97.4% R0, 2.6% R1; GPS 1: 90.0% R0, 10.0% R1; GPS 2: 77.3% R0, 22.7% R1; p=0.044), reduced overall survival (GPS 0: median 25.2 months; GPS 1: 15.3; GPS 2: 5.8; p=0.016) with median overall survival in the whole cohort being 16.2 months (range 0.1-106.0) and perioperative mortality (GPS 0: 7.1% of all perioperative deaths, GPS 1: 35.7%, GPS 2: 57.2%; p=0.004). Furthermore, GPS was identified as an independent prognostic factor for overall survival (p= 0.033). A gradual decrease in overall survival between GPS subgroups was evident.
Conclusions
GPS represents a prognostic factor for long-term outcome in resected GC patients without perioperative treatment.
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