title: The Modified Glasgow Prognostic Score and Survival in Colorectal Cancer: A Pooled Analysis of the Literature.
abstract: BACKGROUND
  It has been reported that the combination of inflammation parameters, such as albumin and C-reactive protein, in the modified Glasgow prognostic score (m-GPS) is a poor prognostic indicator in several malignancies. Here, we quantify the prognostic impact of this score and assess its value in colorectal cancer.
  
  
  METHODS
  A systematic review of electronic databases was conducted to identify publications exploring the association of m-GPS with outcome in colorectal cancer. Overall survival (OS) was the primary outcome, and cancer-specific survival (CSS), progression-free survival, and disease-free survival were secondary outcomes. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) were included in a metaanalysis. Pooled HRs were computed and weighted using generic inverse-variance and random effects modeling. All statistical tests were two-sided.
  
  
  RESULTS
  Nine studies, which included a total of 2,227 patients, were included in the analysis. Overall, according to multivariate analysis, m-GPS≥1 was independently associated with an HR for OS of 1.69 (95% CI=1.4-2.04; P<0.00001), an effect observed in all stages of disease. Six studies including a total of 1,751 patients reported HR for CSS. Overall, a high m-GPS was associated with an HR for CSS of 1.84 (95% CI=1.43-2.37; P<0.00001).
  
  
  CONCLUSIONS
  A high m-GPS is associated with poor OS in colorectal cancer. The m-GPS is a cheap and easily evaluable biomarker, and its incorporation into known prognostic scores for clinical decision making warrants further investigation in this setting.
authors.affiliation: Piazzale Ospedale 1, 24047 Treviglio (BG). faupe@libero.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
authors.forename: Andrea
authors.initials: A
authors.lastname: Coinu
authors.forename: Paola
authors.initials: P
authors.lastname: Bertocchi
authors.forename: Karen
authors.initials: K
authors.lastname: Borgonovo
authors.forename: Mary
authors.initials: M
authors.lastname: Cabiddu
authors.forename: Mara
authors.initials: M
authors.lastname: Ghilardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Zaniboni
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality*; D018572:Disease-Free Survival; D006801:Humans; D011379:Prognosis