title: Glasgow Prognostic Score may be a prognostic index for overall and perioperative survival in gastric cancer without perioperative treatment.
abstract: Systemic inflammation is a key factor in tumor growth. C-reactive protein and albumin are parameters of systemic inflammation from the Glasgow Prognostic Score (GPS). The purpose was to evaluate the prognostic role of GPS in a homogeneous population of gastric cancer patients undergoing surgical treatment only.
  
  
  
  Patients underwent operations between 2009 and 2014. Those who had received perioperative treatment or had other malignancies or inflammatory diseases were excluded. Eighty-eight patients met all inclusion criteria (age >18 years, documented preoperative serum levels of albumin and C-reactive protein, histologically proven gastric cancer, curative operation, including lymphadenectomy). C-reactive protein and albumin levels were retrieved from our prospective database. GPS was correlated with clinicopathologic characteristics and outcome.
  
  
  
  Increasing GPS was linked to aggressive tumor biology in terms of tumor size (GPS 0: 51.2% T1 and T2, 48.8% T3 and T4; GPS 1: 23.8% T1 and T2, 76.2% T3 and T4; GPS 2: 23.1% T1 and T2, 76.9% T3 and T4; P = .026), synchronous distant metastases (GPS 0: 47.1% M0, 0.0% M1; GPS 1: 25.9% M0, 0.0% M1; GPS 2: 27.1% M0, 100.0% M1; P = .030), venous vessel invasion (GPS 0: 91.2% V0, 8.8% V1; GPS 1: 66.7% V0, 33.3% V1; GPS 2: 55.0% V0, 45.0% V1; P = .008), resection margin status (GPS 0: 97.4% R0, 2.6% R1; GPS 1: 90.0% R0, 10.0% R1; GPS 2: 77.3% R0, 22.7% R1; P = .044), reduced overall survival (GPS 0: median 25.2 months [range 0.4-106.0]; GPS 1: 15.3 [0.2-59.5]; GPS 2: 5.8 [0.1-55.3]; P = .016) with median overall survival in the whole cohort being 16.2 months (range 0.1-106.0) and perioperative mortality (GPS 0: 0.0% of perioperative deaths, GPS 1: 20.0%, GPS 2: 80.0%; P = .036). Furthermore, GPS was identified as an independent prognosticator of overall survival (P = .033). A gradual decrease in survival between GPS subgroups was evident.
  
  
  
  GPS represents an independent prognostic factor for long-term outcome in resected gastric cancer patients without perioperative treatment and is strongly associated with perioperative mortality.
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: n.melling@uke.de.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Melling
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Amica
authors.initials: A
authors.lastname: Grüning
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Tachezy
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Nentwich
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reeh
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.affiliation: Department of General, Visceral, and Thoracic Surgery at the University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Dean
authors.initials: D
authors.lastname: Bogoevski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein