Elsevier

European Journal of Cancer

Volume 47, Issue 17, November 2011, Pages 2633-2641
European Journal of Cancer

A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study

https://doi.org/10.1016/j.ejca.2011.03.028Get rights and content

Abstract

Introduction

Components of the systemic inflammatory response, combined to form inflammation-based prognostic scores (modified Glasgow Prognostic Score (mGPS), Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI), Prognostic Nutritional Index (PNI)) have been associated with cancer specific survival. The aim of the present study was to compare the prognostic value of these scores.

Methods

Patients (n = 27,031) who had an incidental blood sample taken between 2000 and 2007 for C-reactive protein, albumin, white cell, neutrophil, lymphocyte and platelet counts, as well as a diagnosis of cancer (Scottish Cancer Registry) were identified. Of this group 8759 patients who had been sampled within two years following their cancer diagnosis were studied.

Results

On follow up, there were 5163 deaths of which 4417 (86%) were cancer deaths. The median time from blood sampling to diagnosis was 1.7 months. An elevated mGPS, NLR, PLR, PI and PNI were predictive of a reduced cancer specific survival independent of age, sex and deprivation and tumour site (all p < 0.001). The area under the receiver operator curves was greatest for mGPS and PI. Specifically, in colorectal cancer, an elevated mGPS and PI were predictive of a reduced cancer specific survival independent of age, sex, deprivation and tumour stage (both p < 0.001).

Conclusion

The results of the present study show that systemic inflammation-based scores, in particular the mGPS and PI, have prognostic value in cancer independent of tumour site. Based on the present results and the existing validation literature, the mGPS should be included in the routine assessment of all patients with cancer.

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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