Influence of inflammation-based prognostic score on mortality of patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer

• Published in: Annals of surgery Vol. 250; no. 2; p. 268
• Main Authors: Ishizuka, Mitsuru, Nagata, Hitoshi, Takagi, Kazutoshi, Kubota, Keiichi
• Format: Journal Article
• Language: English
• Published: United States 01.08.2009
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; C-Reactive Protein - metabolism; CA-19-9 Antigen; Camptothecin - analogs & derivatives; Camptothecin - therapeutic use; Cohort Studies; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Female; Fluorouracil - therapeutic use; Health Status Indicators; Humans; Leucovorin - therapeutic use; Male; Middle Aged; Organoplatinum Compounds - therapeutic use; Predictive Value of Tests; Retrospective Studies; Serum Albumin - metabolism; Survival Analysis; Treatment Outcome
• ISSN: 1528-1140
• DOI: 10.1097/sla.0b013e3181b16e24

Recent studies have revealed that the modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the mGPS in patients undergoing chemotherapy for far-advanced or recurrent unresectable colorectal cancer (AR-UCRC). To demonstrate the influence of the mGPS for prognostication of patients undergoing chemotherapy for AR-UCRC. The mGPS was calculated as follows: patients with an elevated level of CRP (>1.0 mg/dL) were allocated a mGPS of 1 or 2 depending on the absence or presence of hypoalbuminemia (<3.5 g/dL) and patients showing no elevated level of CRP (< or =1.0 mg/dL) were allocated a mGPS of 0. Prognostic significance was analyzed by Kaplan-Meier, univariate, and multivariate analyses. One hundred twelve patients who had undergone chemotherapy for AR-UCRC with regimens such as FOLFIRI (5-fluorouracil/l-leucovorin/irinotecan hydrochloride) or FOLFOX (5-fluorouracil/oxialiplatin) were evaluated retrospectively. Kaplan-Meier analysis and log-rank test revealed that mGPS 2 predicted a higher risk of mortality than mGPS 0 or 1 (P < 0.0001). Univariate analyses revealed that the neutrophil ratio (P = 0.0411), CA 19-9 (P = 0.0473), CRP (P = 0.0477), albumin (P = 0.0043), and mGPS (0, 1/2) (P < 0.0001) were associated with mortality. Multivariate analyses using these 5 factors revealed that only mGPS (0, 1/2) (odds ratio: 6.071; 95% CI: 1.625-22.68; P = 0.0073) was an independent risk factor of mortality. mGPS is an important and independent predictor of mortality in patients undergoing chemotherapy for AR-UCRC.