A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study
Introduction
Cancer incidence is increasing in the United Kingdom as well as on a global basis.1 Over 1 in 3 people in the UK will develop cancer during their lifetime with around 150,000 people dying each year as a consequence.2, 3 Such a burden of disease accounts for a significant proportion of annual healthcare spending in the UK, US and worldwide.1, 4
Although it is recognised that the development of cancer has a genetic basis, there is increasing evidence that the host inflammatory response plays an important role in the development and progression of cancer.5, 6, 7, 8, 9 In particular the systemic inflammatory response, as evidence by C-reactive protein, plays an important role in the progression of a variety of common solid tumours.10 The measurement of the systemic inflammatory response has been subsequently refined using a selective combination of C-reactive protein and albumin (termed the modified Glasgow Prognostic Score, mGPS) and has been shown to have prognostic value, independent of tumour stage, in lung, gastrointestinal and renal cancers.11, 12
It is also of interest that other haematological components of the systemic inflammatory response have been combined to form inflammation-based prognostic scores that have been associated with survival in patients with cancer (Table 1). The Neutrophil Lymphocyte Ratio (NLR), a combination of circulating neutrophil and lymphocyte counts,13 has been associated with survival in lung14, 15 and ovarian16 cancers. The Platelet Lymphocyte Ratio (PLR), a combination of circulating platelet and lymphocyte counts, has been associated this survival in patients with pancreatic cancer.17 The combination of C-reactive protein and white cell count in a Prognostic Index (PI) has been associated with survival in patients with lung cancer.18 Finally, Onodera’s Prognostic Nutritional Index (PNI) has also been associated with survival in patients with pancreatic,19 gastric20 and oesophageal cancer.21
More recently it has been shown that, in a large cohort study (Glasgow Inflammation Outcome Study) that the mGPS is elevated in patients with cancer22 and predictive of survival across all tumour sites studied independent of age, sex and deprivation.23 Therefore, it is of considerable interest to compare the prognostic value of the mGPS, NLR, PLR, PI and PNI across different tumour sites.
The aim of the present study was to compare the prognostic value of the mGPS, NLR, PLR, PI and PNI adjusted for age, sex, deprivation and tumour site in the Glasgow Inflammation Outcome Study. We hypothesised that these systemic inflammation-based prognostic scores at the time of diagnosis would all predict cancer survival.
Section snippets
Study design
From a cohort previously described,22 cancer patients in North Glasgow, who had a single blood sample taken for C-reactive protein, albumin, calcium, white cell, neutrophil, lymphocyte and platelet counts were included. Briefly, patients who were sampled incidentally between the 1st January 2000 and the 31st December 2007 were considered and if more than one set of measurements were available for a given patient, only the initial set was used. Cancer diagnosis was established through linkage
Results
From the Glasgow Inflammation Outcome Study of 223,303 patients originally described,22 27,031 patients were identified as having a diagnosis of cancer Scottish Cancer Registry and a blood sample for C-reactive protein, albumin, white cell, neutrophil, lymphocyte and platelet counts taken between January 2000 and December 2007. Within this identified group there were 8759 patients who had been sampled within two years following a diagnosis of cancer and were included in the present study. The
Discussion
The results of the present study show clearly that systemic inflammation-based prognostic scores, whether it be the mGPS, NLR, PLR, PI or PNI, predict cancer specific outcome in most cancers. Moreover, those scores based on C-reactive protein, an acute phase protein, (mGPS and PI) were superior, in terms of differentiating good from poor prognostic groups in a variety of tumour sites, to those based on components of the circulating white cell count (NLR, PLR) or in combination with albumin
Conflict of interest statement
None declared.
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