title: Utility of inflammation-based prognostic scoring in patients given systemic chemotherapy first-line for advanced inoperable bladder cancer.
abstract: OBJECTIVE
  Our intent was to investigate the impact of specific parameters-clinical status, performance status (Eastern Cooperative Oncology Group (ECOG)), C-reactive protein, serum albumin, and inflammation (Glasgow Prognostic Score)-on progression-free survival and overall survival in patients given systemic chemotherapy as the first-line treatment of advanced bladder cancer.
  
  
  METHODS
  A total of 67 patients treated for advanced bladder cancer in a 7-year period (2004-10) were reviewed. Prior to administration of first-line chemotherapy (gemcitabine plus cisplatin), baseline ECOG performance status, C-reactive protein, albumin, Glasgow Prognostic Score and clinical status were assessed. Patients with both elevated C-reactive protein (>1.0 mg/dl) and low albumin (<3.5 mg/dl) were assigned a Glasgow Prognostic Score of 2, while lesser scores were set when one (Glasgow Prognostic Score 1) or both levels (Glasgow Prognostic Score 0) were within the normal range. To evaluate relationships to progression-free survival and overall survival, univariate and multivariate analyses were conducted.
  
  
  RESULTS
  By multivariate analysis,  ECOG performance status (hazard ratio = 3.48, 95% confidence interval 1.87-6.45, P = 0.001) and hypoalbuminemia (hazard ratio = 2.04, 95% confidence interval 1.10-3.78, P = 0.023) were found to be factors independently associated with reduced progression-free survival. Factors independently associated with shortened overall survival were ECOG performance status (hazard ratio = 5.32, 95% confidence interval 2.22-12.71, P = 0.001) and Glasgow Prognostic Score 2 (hazard ratio = 7.00, 95% confidence interval 2.53-19.36, P = 0.001).
  
  
  CONCLUSIONS
  These outcomes indicate that a systemic inflammatory response coupled with hypoalbuminemia (Glasgow Prognostic Score 2) correlates significantly with shortened overall survival and may thus be useful as a prognostic index in this setting.
authors: Department of Urology, Chonnam National University Medical School, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. urokwon@gmail.com
authors: Eu Chang
authors: EC
authors: Hwang
authors: In Sang
authors: IS
authors: Hwang
authors: Ho Song
authors: HS
authors: Yu
authors: Sun-Ouck
authors: SO
authors: Kim
authors: Seung Il
authors: SI
authors: Jung
authors: Jun Eul
authors: JE
authors: Hwang
authors: Taek Won
authors: TW
authors: Kang
authors: Dong Deuk
authors: DD
authors: Kwon
authors: Kwangsung
authors: K
authors: Park
authors: Soo Bang
authors: SB
authors: Ryu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D002097:C-Reactive Protein / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002097:C-Reactive Protein; D002945:Cisplatin; D000093542:Gemcitabine