title: Preoperative Glasgow Prognostic Score as additional independent prognostic parameter for patients with esophageal cancer after curative esophagectomy.
abstract: BACKGROUND
  Inflammation accelerates tumor growth followed by reduced survival in patients with cancer. The aim of this study was to evaluate the prognostic relevance of preoperatively increased levels of C-reactive protein (CRP) and the corresponding Glasgow Prognostic Score (GPS) on patients with esophageal carcinoma undergoing curative esophagectomy.
  
  
  METHODS
  The data of 174 operated esophageal cancer patients were evaluated retrospectively. Patient's demographic and clinico-pathological data, tumor specific data, preoperative plasma levels of CRP and albumin, the corresponding GPS, overall survival (OS) and progression free survival (PFS) were assessed.
  
  
  RESULTS
  103 (59.2%) had adenocarcinoma and 71 (40.8%) had squamous cell carcinoma. 71 patients (43%) had elevated CRP concentrations. 118 patients (71%) had GPS 0, 41 (25%) GPS 1 and 8 (4%) GPS 2. Mean GPS was 0.3 (0-2). 5-year OS was higher in patients with normal CRP than in those with increased CRP (68% vs. 39%; p = 0.007). 5-year OS in patients with GPS 0 and GPS 1 and 2 were 65% and 31% (p = 0.001). 5-year OS for the whole cohort was 56% (1 year: 83%, 3 years: 64%). Recurrence rate was 16.1% closely associated with GPS (p = 0.002). Median follow-up was 23 months (0-118 months). In multivariate analysis GPS, lymph node involvement, T stage and tumor histology were the independent prognostic parameters (p = 0.004, <0.001, 0.035, 0.010).
  
  
  CONCLUSIONS
  Preoperatively increased GPS is significantly associated with reduced postoperative survival and tumor recurrence. The GPS as an independent prognosticator should be interpreted together with the TNM stage when the further postoperative treatment has to be scheduled.
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria. Electronic address: jo.lindenmann@medunigraz.at.
authors.forename: J
authors.initials: J
authors.lastname: Lindenmann
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Fink-Neuboeck
authors.affiliation: Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Avian
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Pichler
authors.affiliation: Department of Cell Stress Biology, Photodynamic Therapy Center at the Roswell Park Cancer Institute, University at Buffalo-State University of New York, Buffalo, USA.
authors.forename: M
authors.initials: M
authors.lastname: Habitzruther
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria.
authors.forename: F M
authors.initials: FM
authors.lastname: Smolle-Juettner
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: C-reactive protein; Esophageal cancer; Esophagectomy; Glasgow Prognostic Score; Prognosis; Survival