Clinical Research Papers:
The systemic inflammation-based Glasgow Prognostic Score as a powerful prognostic factor in patients with upper tract urothelial carcinoma
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Teruo Inamoto1, Hideyasu Matsuyama2, Shigeru Sakano2, Naokazu Ibuki1, Kiyoshi Takahara1, Kazumasa Komura1, Tomoaki Takai1, Takuya Tsujino1, Yuki Yoshikawa1, Koichiro Minami1, Kazuhiro Nagao2, Ryo Inoue2 and Haruhito Azuma1
1Department of Urology, Osaka Medical College, Osaka, Japan
2Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Teruo Inamoto, email: email@example.com
Keywords: Glasgow Prognostic Score; upper tract urothelial carcinoma; prognosis
Received: June 27, 2017 Accepted: October 30, 2017 Published: November 23, 2017
Introduction and Objective: The combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with varying cancers, except for upper tract urothelial carcinoma (UTUC). The aim of this study was to describe the relationship between GPS and survival in patients with UTUC after adjustment for other prognostic factors.
Materials and Methods: We queried 2 UTUC databases. Retrospective clinical series on patients with localized UTUC managed by nephroureterectomy with bladder cuff, for whom data from the Yamaguchi Uro-Oncology Group and Osaka Medical College registry, including age, presence of bladder cancer, pT stage, lymphovascular invasion, C-reactive protein (CRP) and albumin, were analyzed. The GPS was constructed by combining CRP and albumin. Cancer specific survival (CSS) and overall survival (OS) and relative excess risk of death were estimated by GPS categories after adjusting for gender, age, ECOG performance status (PS), grade, and lymphovascular invasion (LVI).
Results: Seven hundred and twenty four UTUC patients were identified. Our final cohort included 574 patients; of these, 29.2% died during a maximum follow up of 16.7 years. The estimated mean 10-year CSS of patients with GPS of scre-0, -1, and -2 was 99.5, 95.1, and 75.9 months, respectively. Patients with GPS of score-2 had poorest 10-year estimated mean OS of 67.6 months (57.2–77.9). Raised GPS also had a significant association with excess risk of cancer death at 10 years (GPS 2: Relative Excess Risk = 1.74, 95% CI 1.20–2.54) after adjusting for gender, patients’ age, ECOG PS, and tumor focality. C-index of GPS both for CSS and OS were superior to patients’ age and tumor focality, and comparable to grade.
Conclusions: The GPS is an independent prognostic factor for CSS and OS after surgery with curative intent for localized UTUC. It significantly increases the accuracy of established prognostic factors. The GPS may provide a meaningful adjunct for patient counseling and clinical trial design.
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