The Relationship Between an Inflammation-based Prognostic Score (Glasgow Prognostic Score) and Changes in Serum Biochemical Variables in Patients with Advanced Lung and Gastrointestinal Cancer

Overview

Journal J Clin Pathol

Specialty Pathology

Date 2006 Apr 29

PMID 16644880

Citations 45

Authors

D J F Brown

R Milroy

T Preston

D C McMillan

Affiliations

Soon will be listed here.

Abstract

Background: The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score formed from standard thresholds of C reactive protein (CRP) and albumin, has prognostic value in patients with advanced cancer. Little is known about the general biochemical disturbance associated with the systemic inflammatory response in cancer.

Aim: To examine the relationship between the GPS and blood biochemistry in patients with advanced lung and gastrointestinal cancer.

Methods: The GPS (albumin <35 g/l = 1 and CRP >10 mg/l = 1 combined to form a prognostic score of 0 (normal) and 1 or 2 (abnormal)) and a variety of biochemical variables were examined in patients (n = 50) with advanced lung or gastrointestinal cancer and in a healthy control group (n = 13).

Results: The GPS was normal in all the controls, but abnormal in 78% of the cancer group. Serum levels of sodium, chloride, creatine kinase, zinc and vitamin D were lower in the cancer group (all p<0.01), whereas levels of calcium, copper (both p<0.05), alkaline phosphatase, gamma-glutamyl transferase (both p<0.001) and lactate dehydrogenase (p<0.10) were raised. In the patient group, with increasing GPS, there was a median reduction in Karnofsky Performance Status (25%), haemoglobin (22%), sodium (3%), zinc (15%) and survival (93%, all p<0.05) and a median increase in white cell count (129%), alkaline phosphatase (217%), gamma-glutamyl transferase (371%) and lactate dehydrogenase (130%, all p<0.05). CRP levels were strongly and similarly correlated with alkaline phosphatase and gamma-glutamyl transferase, accounting for more than 25% of the variation in their activities.

Conclusion: Several correlations were seen between biochemical variables and increasing GPS. In particular, chronic activation of the systemic inflammatory response in cancer was associated with increase in gamma-glutamyl transferase and alkaline phosphatase activity in patients with advanced lung and gastrointestinal cancer.

Citing Articles

Mendelian randomization study of the relationship between blood and urine biomarkers and lung cancer.

Huang H, Zheng H Front Oncol. 2024; 14:1453246.

PMID: 39687887 PMC: 11646849. DOI: 10.3389/fonc.2024.1453246.

The association between an inflammation-based nutritional tool (Glasgow Prognostic Score) and length of hospital stay in patients with haematological cancer.

Song A, Ni B, Tang M, Zhou Y, Zhang X, Chen Z Support Care Cancer. 2024; 32(12):804.

PMID: 39557734 DOI: 10.1007/s00520-024-09021-0.

Sixth-Week Immune-Nutritional-Inflammatory Biomarkers: Can They Predict Clinical Outcomes in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors?.

Olgun P, Diker O Curr Oncol. 2023; 30(12):10539-10549.

PMID: 38132403 PMC: 10742278. DOI: 10.3390/curroncol30120769.

The Glasgow Prognostic Score Predicts Survival in Patients with Advanced Non-Small Cell Lung Cancer Harboring Sensitive Epidermal Growth Factor Receptor Mutations Who Are Treated with Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors.

Akazawa Y, Igawa S, Yamada K, Yamamoto H, Yagami Y, Kaizuka N Oncology. 2023; 101(11):685-694.

PMID: 37166346 PMC: 10614514. DOI: 10.1159/000530809.

The Role of Perioperative C-Reactive Protein in Predicting the Prognosis of Epithelial Ovarian Carcinoma.

Pan Q, Wei M, Lu M, Xu Y, Xie X, Li X Cancer Manag Res. 2023; 15:233-243.

PMID: 36873254 PMC: 9983572. DOI: 10.2147/CMAR.S385974.

References

OGorman P, McMillan D, McArdle C . Longitudinal study of weight, appetite, performance status, and inflammation in advanced gastrointestinal cancer. Nutr Cancer. 2000; 35(2):127-9. DOI: 10.1207/S15327914NC352_5. View

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003; 89(6):1028-30. PMC: 2376960. DOI: 10.1038/sj.bjc.6601242. View

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004; 90(9):1704-6. PMC: 2409737. DOI: 10.1038/sj.bjc.6601789. View

Mahmoud F, Rivera N . The role of C-reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep. 2002; 4(3):250-5. DOI: 10.1007/s11912-002-0023-1. View

Forrest L, McMillan D, McArdle C, Angerson W, Dagg K, Scott H . A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2005; 92(10):1834-6. PMC: 2361776. DOI: 10.1038/sj.bjc.6602591. View

Rivory L, Slaviero K, Clarke S . Hepatic cytochrome P450 3A drug metabolism is reduced in cancer patients who have an acute-phase response. Br J Cancer. 2002; 87(3):277-80. PMC: 2364233. DOI: 10.1038/sj.bjc.6600448. View

McMillan D, Scott H, Watson W, Preston T, Milroy R, McArdle C . Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients. Nutr Cancer. 1998; 31(2):101-5. DOI: 10.1080/01635589809514687. View

Bromwich E, McMillan D, Lamb G, Vasey P, Aitchison M . The systemic inflammatory response, performance status and survival in patients undergoing alpha-interferon treatment for advanced renal cancer. Br J Cancer. 2004; 91(7):1236-8. PMC: 2409897. DOI: 10.1038/sj.bjc.6602152. View

McMillan D, Sattar N, Talwar D, OReilly D, McArdle C . Changes in micronutrient concentrations following anti-inflammatory treatment in patients with gastrointestinal cancer. Nutrition. 2000; 16(6):425-8. DOI: 10.1016/s0899-9007(00)00270-7. View

10.

Elahi M, McMillan D, McArdle C, Angerson W, Sattar N . Score based on hypoalbuminemia and elevated C-reactive protein predicts survival in patients with advanced gastrointestinal cancer. Nutr Cancer. 2004; 48(2):171-3. DOI: 10.1207/s15327914nc4802_6. View

11.

McMillan D, Watson W, OGorman P, Preston T, Scott H, McArdle C . Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2002; 39(2):210-3. DOI: 10.1207/S15327914nc392_8. View

12.

Vigano A, Bruera E, Jhangri G, Newman S, Fields A, Suarez-Almazor M . Clinical survival predictors in patients with advanced cancer. Arch Intern Med. 2000; 160(6):861-8. DOI: 10.1001/archinte.160.6.861. View

13.

Al-Shaiba R, McMillan D, Angerson W, Leen E, McArdle C, Horgan P . The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases. Br J Cancer. 2004; 91(2):205-7. PMC: 2409827. DOI: 10.1038/sj.bjc.6601886. View

14.

Scott H, McMillan D, Forrest L, Brown D, McArdle C, Milroy R . The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer. 2002; 87(3):264-7. PMC: 2364225. DOI: 10.1038/sj.bjc.6600466. View

15.

OGorman P, McMillan D, McArdle C . Prognostic factors in advanced gastrointestinal cancer patients with weight loss. Nutr Cancer. 2000; 37(1):36-40. DOI: 10.1207/S15327914NC3701_4. View