Significance of the Glasgow Prognostic Score as a prognostic indicator for lung cancer surgery.
OBJECTIVE
The Glasgow Prognostic Score (GPS), which is calculated with C-reactive protein (CRP) and albumin (Alb) values, is a prognostic indicator for various types of cancers. However, its role in lung cancer still remains unclear, and its optimal cut-off values are controversial. Here, we evaluated the significance of the GPS and adjusted GPS (a-GPS) using our institution's cut-off values in patients undergoing resection for primary lung cancer.


METHODS
We analysed 1043 lung cancer patients who underwent resection between 1998 and 2012. The overall survival (OS) probabilities of the GPS subgroups were estimated using the Kaplan-Meier method and were compared using the log-rank test. The prognostic significance of the GPS and the a-GPS was assessed by the Cox proportional hazards model with clinicopathological variables and inflammation markers, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). The GPS was calculated based on cut-off values of 1.0 mg/dl for CRP and 3.5 g/dl for Alb, as previously reported. The a-GPS was calculated based on cut-off values 0.3 mg/dl for CRP and 3.9 g/dl for Alb, which are the standard thresholds used by our institution.


RESULTS
The GPS and the a-GPS were correlated with preoperative factors, such as age, sex, smoking status, the NLR and the PLR, and oncological factors, including the pathological stage, histological type and level of lymphovascular invasion. The 5-year OS rates were 82, 55 and 55% with GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.66), respectively, and 88, 67 and 59% with a-GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.04), respectively. Multivariable analysis revealed that the GPS [1 vs 0, hazard ratio (HR): 1.63, 2 vs 0, HR: 1.44] and the a-GPS (1 vs 0, HR: 2.00, 2 vs 0, HR: 2.10) were independent prognostic factors. The a-GPS classification showed a clearer prognostic distribution than the GPS classification.


CONCLUSIONS
The GPS is a useful prognostic indicator of the OS in lung cancer surgery. The optimal cut-off values for GPS estimation may need to be re-evaluated.
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Mitsuaki
M
Kawashima
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan murakawa-tky@umin.ac.jp.
Tomohiro
T
Murakawa
Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tomohiro
T
Shinozaki
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Junji
J
Ichinose
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Haruaki
H
Hino
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Chihiro
C
Konoeda
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Takehiro
T
Tsuchiya
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Tomonori
T
Murayama
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kazuhiro
K
Nagayama
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jun-ichi
J
Nitadori
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masaki
M
Anraku
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jun
J
Nakajima
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
Albumin; C-reactive protein; Inflammation; Lung neoplasms; Risk factors; Surgery