External validation of the modified Glasgow prognostic score for renal cancer.
OBJECTIVE
The modified Glasgow prognostic Score (mGPS) incorporates C-reactive protein and albumin as a clinically useful marker of tumor behavior. The ability of the mGPS to predict metastasis in localized renal cell carcinoma (RCC) remains unknown in an external validation cohort.


METHODS
Patients with clinically localized clear cell RCC were followed for 1 year post-operatively. Metastases were identified radiologically. Patients were categorized by mGPS score as low-risk (mGPS = 0 points), intermediate-risk (mGPS = 1 point) and high-risk (mGPS = 2 points). Univariate, Kaplan-Meier and multivariate Cox regression analyses examined Recurrence -free survival (RFS) across patient and disease characteristics.


RESULTS
Of the 129 patients in this study, 23.3% developed metastases. Of low, intermediate and high risk patients, 10.1%, 38.9% and 89.9% recurred during the study. After accounting for various patient and tumor characteristics in multivariate analysis including stage and grade, only mGPS was significantly associated with RFS. Compared with low-risk patients, intermediate- and high-risk patients experienced a 4-fold (hazard ratios [HR]: 4.035, 95% confidence interval [CI]: 1.312-12.415, P = 0.015) and 7-fold (HR: 7.012, 95% CI: 2.126-23.123 P < 0.001) risk of metastasis, respectively.


CONCLUSIONS
mGPS is a robust predictor of metastasis following potentially curative nephrectomy for localized RCC. Clinicians may consider mGPS as an adjunct to identify high-risk patients for possible enrollment into clinical trials or for patient counseling.
Department of Urology, Emory University, Atlanta, Georgia, USA.
Caroline G
CG
Tai
Department of Urology, Emory University, Atlanta, Georgia, USA.
Timothy V
TV
Johnson
Department of Urology, Emory University, Atlanta, Georgia, USA.
Ammara
A
Abbasi
Department of Urology, Emory University, Atlanta, Georgia, USA.
Lindsey
L
Herrell
Department of Urology, Emory University, Atlanta, Georgia, USA.
Wayne B
WB
Harris
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Omer
O
Kucuk
Department of Urology, Emory University, Atlanta, Georgia, USA.
Daniel J
DJ
Canter
Department of Urology, Emory University, Atlanta, Georgia, USA.
Kenneth
K
Ogan
Department of Urology, Emory University, Atlanta, Georgia, USA.
John G
JG
Pattaras
Department of Urology, Emory University, Atlanta, Georgia, USA.
Peter T
PT
Nieh
Department of Urology, Emory University, Atlanta, Georgia, USA.
Viraj A
VA
Master
Albumin; C-reactive protein; biological markers; metastasis; renal cell carcinoma