title: Validation of the Modified Glasgow Prognostic Score in Advanced Cancer Patients Receiving Palliative Care.
abstract: BACKGROUND
  The modified Glasgow Prognostic Score (mGPS) is a well-known marker of systemic inflammatory response previously associated with poor prognoses in cancer.
  
  
  OBJECTIVE
  We investigated the relationships between mGPS and clinical variables and the prognostic impact of mGPS in patients with advanced cancer starting palliative care (PC).
  
  
  METHODS
  Data from two prospective studies conducted at a tertiary cancer center were analyzed (N = 459). Data regarding patient characteristics, Karnofsky Performance Status, and blood samples were collected at the initial evaluation. The mGPS was calculated as follows: C-reactive protein (CRP) < 10 mg/L = 0; CRP > 10 mg/L = 1, CRP > 10 mg/L and albumin < 35 g/L = 2. Chi-square or Fisher exact tests were used for comparisons of categorical variables; continuous variables were compared using the Mann-Whitney U test. For the survival analysis, Cox regression analyses were performed.
  
  
  RESULTS
  mGPS of 0, 1, and 2 were assigned to 79.7%, 6.8%, and 13.5% of the patients, respectively. A positive association between hepatic metastasis (P = 0.004), primary lung cancer (P = 0.021), PC only (P < 0.001), lower Karnofsky Performance Status (P < 0.001), and higher systemic inflammation (mGPS 1/2) was found. Median overall survival was 1, 3, and 5.7 months for mGPS of 2, 1, and 0, respectively. After multivariate analyses, mGPS remained an independent prognostic marker (mGPS 1, hazard ratio 2.066, P = 0.001; mGPS 2, hazard ratio 2.664, P < 0.001).
  
  
  CONCLUSIONS
  Systemic inflammatory response is associated with a low functional status, primary lung cancers, and tumors with hepatic metastasis. When starting PC, an mGPS definition may have clinical utility implications, by identifying three groups of patients with advanced cancer patients with distinct survival outcomes.
authors.affiliation: Researcher Support Center, Learning and Research Institute, Barretos, São Paulo, Brazil; Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos, São Paulo, Brazil.
authors.forename: Naitielle de Paula
authors.initials: Nde P
authors.lastname: Pantano
authors.affiliation: Researcher Support Center, Learning and Research Institute, Barretos, São Paulo, Brazil; Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos, São Paulo, Brazil.
authors.forename: Bianca Sakamoto Ribeiro
authors.initials: BS
authors.lastname: Paiva
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Researcher Support Center, Learning and Research Institute, Barretos, São Paulo, Brazil; Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Electronic address: caredupai@gmail.com.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Paiva
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D062072:Patient Acuity; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D016019:Survival Analysis; D062606:Tertiary Care Centers
keywords: Cancer; Glasgow Prognostic Score; inflammation; palliative care; prognostic markers