The relationship between an inflammation-based prognostic score (Glasgow Prognostic Score) and changes in serum biochemical variables in patients with advanced lung and gastrointestinal cancer.
BACKGROUND
The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score formed from standard thresholds of C reactive protein (CRP) and albumin, has prognostic value in patients with advanced cancer. Little is known about the general biochemical disturbance associated with the systemic inflammatory response in cancer.


OBJECTIVE
To examine the relationship between the GPS and blood biochemistry in patients with advanced lung and gastrointestinal cancer.


METHODS
The GPS (albumin <35 g/l = 1 and CRP >10 mg/l = 1 combined to form a prognostic score of 0 (normal) and 1 or 2 (abnormal)) and a variety of biochemical variables were examined in patients (n = 50) with advanced lung or gastrointestinal cancer and in a healthy control group (n = 13).


RESULTS
The GPS was normal in all the controls, but abnormal in 78% of the cancer group. Serum levels of sodium, chloride, creatine kinase, zinc and vitamin D were lower in the cancer group (all p<0.01), whereas levels of calcium, copper (both p<0.05), alkaline phosphatase, gamma-glutamyl transferase (both p<0.001) and lactate dehydrogenase (p<0.10) were raised. In the patient group, with increasing GPS, there was a median reduction in Karnofsky Performance Status (25%), haemoglobin (22%), sodium (3%), zinc (15%) and survival (93%, all p<0.05) and a median increase in white cell count (129%), alkaline phosphatase (217%), gamma-glutamyl transferase (371%) and lactate dehydrogenase (130%, all p<0.05). CRP levels were strongly and similarly correlated with alkaline phosphatase and gamma-glutamyl transferase, accounting for more than 25% of the variation in their activities.


CONCLUSIONS
Several correlations were seen between biochemical variables and increasing GPS. In particular, chronic activation of the systemic inflammatory response in cancer was associated with increase in gamma-glutamyl transferase and alkaline phosphatase activity in patients with advanced lung and gastrointestinal cancer.
Brown
D J F
DJ
St Columba's Hospice, Edinburgh, UK. dbrown@stcolumbashospice.org.uk
Milroy
R
R
Preston
T
T
McMillan
D C
DC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000097:blood / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D005723:gamma-Glutamyltransferase / Q000097:blood
D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase