title: Systemic inflammation and survival of patients with prostate cancer: evidence from the Glasgow Inflammation Outcome Study.
abstract: BACKGROUND
  There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer; however, it is unclear whether this is independent of grade. We therefore investigated the role of inflammation-based prognostic scores, the modified Glasgow Prognostic Score (mGPS) and neutrophil lymphocyte ratio (NLR), and their associations with Gleason grade in patients with prostate cancer.
  
  
  METHODS
  Patients from a cohort, the Glasgow Inflammation Outcome Study, who had diagnosis of prostate cancer, were included in this study. The mGPS was constructed by combining C-reactive protein and albumin whereas NLR by calculating the ratio of neutrophils to lymphocytes. We estimated 5-year relative survival and relative excess risk (RER) of death by mGPS and NLR categories after adjusting for age, socioeconomic circumstances and Gleason grade.
  
  
  RESULTS
  In all, 897 prostate cancer patients were identified; of those 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation appeared to have significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socioeconomic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: RER =2.41, 95% confidence interval 1.37-4.23) among aggressive, clinically significant prostate cancer (Gleason grades 8-10).
  
  
  CONCLUSIONS
  The mGPS is a strong measure of systemic inflammation, when compared with NLR. Prostate cancer patients with a raised mGPS had significantly higher risk of death for overall as well high-grade disease. Inflammation-based prognostic scores predict outcome in patients with prostate cancer and should be added to their routine clinical assessment.
authors.affiliation: Academic Unit of Public Health, Centre for Population & Health Sciences, University of Glasgow, Glasgow, UK. k.shafique.1@research.gla.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Shafique
authors.forename: M J
authors.initials: MJ
authors.lastname: Proctor
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
authors.forename: K
authors.initials: K
authors.lastname: Qureshi
authors.forename: H
authors.initials: H
authors.lastname: Leung
authors.forename: D S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D006801:Humans; D007249:Inflammation / Q000276:immunology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D012306:Risk; D012709:Serum Albumin / Q000032:analysis; D012959:Socioeconomic Factors; D016019:Survival Analysis
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein