The modified Glasgow prognostic score in patients undergoing surgery for bone and soft tissue sarcoma.
BACKGROUND
The prognostic significance of markers of the systemic inflammatory response in patients with soft tissue and bone sarcomas remains unclear. Therefore, the present study aimed to compare the prognostic value of markers of the systemic inflammatory response in patients undergoing surgery for primary soft tissue and bone sarcoma.


METHODS
Patients who underwent resection of primary soft tissue/bone sarcoma between 2008 and 2012 and had pre-operative measurements of the systemic inflammatory response [C-reactive protein, albumin, white cell, neutrophil, lymphocyte and platelet counts, and the combination of C-reactive protein and albumin (mGPS)] were included in the study (n = 111).


RESULTS
The majority of the patients were ≤50 years old (84%), were female (63%), had soft tissue sarcoma (62%), and had tumours >10 cm (52%), mostly of high grade (85%). The median follow-up of survivors was 50 months (range 34-78); 24 (21%) developed local recurrence, 35 (31%) developed distant metastases and 30 (30%) died of their cancer. On univariate analysis, tumour size (P < 0.001), tumour grade (P < 0.001), C-reactive protein level (P < 0.001), albumin level (P < 0.001) and mGPS (P < 0.001) were significantly associated with distant recurrence-free survival. On a multivariate analysis, only tumour size [hazard ratios (HR) 2.57, 95% confidence intervals (CI) 1.14-5.32, P < 0.05], tumour grade (HR 7.01, 95% CI 0.94-52.17, P < 0.10) and mGPS (HR 1.92, 95% CI 1.31-2.83, P < 0.01) were independently associated with distant recurrence-free survival. On a multivariate analysis, only tumour size (HR 2.85, 95% CI 1.10-7.39, P < 0.05) and the mGPS (HR 2.03, 95% CI 1.31-3.16, P < 0.01) were independently associated with cancer-specific survival.


CONCLUSIONS
The systemic inflammatory response, as evidenced by the mGPS, was an important independent predictor of recurrence-free survival and cancer-specific survival in patients undergoing surgery for bone and soft tissue sarcoma.
Academic Unit of Surgery, School of Medicine - University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK; Orthopaedic Surgery Department, Royal Infirmary, Glasgow, G4 0SF, UK; Plastic Surgery Department, Oxford University Hospitals, OX3 9DU, UK. Electronic address: rossel.morhij@gmail.com.
Rossel
R
Morhij
Orthopaedic Surgery Department, Royal Infirmary, Glasgow, G4 0SF, UK.
Ashish
A
Mahendra
Orthopaedic Surgery Department, Royal Infirmary, Glasgow, G4 0SF, UK.
Mike
M
Jane
Academic Unit of Surgery, School of Medicine - University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK.
Donald C
DC
McMillan
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001772:Blood Cell Count; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000401:mortality
D015415:Biomarkers
Bone soft tissue sarcoma; Recurrence; Survival; Systemic inflammation