Inflammation and Lung Cancer Survival
Inflammation and Lung Cancer Survival
Abstract & Commentary
William B. Ershler, MD, INOVA Fairfax Hospital Cancer Center, Fairfax, VA; Director, Institute for Advanced Studies in Aging, Washington, DC, is Editor for Clinical Oncology Alert.
Synopsis: The Glasgow Prognostic Score (GPS) is an easily derived measure of underlying inflammatory processes. In this series of 101 patients with newly diagnosed advanced non-small cell lung carcinoma, it proved superior to the ECOG Performance Scale in predicting survival. After initial treatment, however, the prognostic value fell, but this may have been the result of fewer evaluable patients at the latter time points.
Source: Forrest LM, et al. Br J Cancer. 2005;92:1834-1836.
Non-small cell lung cancer (nsclc) remains the most common cause of cancer related death in the United States. Progression of the disease is characterized by nutritional and functional decline, and some have conjectured this relates to disease-associated systemic inflammation.1,2 The Glasgow Performance Score (GPS) is an inflammation-based scale which, when calculated at initial diagnosis, has been shown to correlate with survival for patients with NSCLC.1 To derive the GPS score, patients with both an elevated C-reactive protein ([CRP] > 10 mg/L) and hypoalbuminemia (< 35 g/L) are allocated a score of 2. Patients in whom only one of the biochemical abnormalities is present are scored 1, and those in whom neither is present, 0.3 The current investigation was undertaken to determine if the GPS would be a useful prognostic determinant at later points in the course of patients with this disease.
For this, 101 patients with inoperable NSCLC were scored at diagnosis and at 3 and 6 months after diagnosis for both GPS and performance status (ECOG). Approximately half of the patients had stage IV disease. At diagnosis, 68% had elevated CRP and 10% had low serum albumin. The majority were ECOG PS 0 or 1. During follow-up, 29 of 42 receiving active’ treatment and 55 of 59 receiving palliative’ treatment died. Only 38 were available for follow-up assessment.
At diagnosis (stratified for treatment, active vs palliative), only the GPS (hazard ratio, 2.32; 95% CI, 1.52-3.54; P < 0.001) was significantly associated with survival. At the follow-up assessment (3-6 months), there was a reduction in ECOG-PS (P < 0.01) and GPS (P < 0.10), but neither were significantly associated with subsequent survival (P = 0.08 for ECOG-PS; P = 0.139 for GPS).
Comment by William B. Ershler, MD
This brief report is of interest because 2 commonly obtained laboratory measures, when used in concert offer prognostic information beyond the more subjective performance status that most oncologists appreciate. Incorporation of this simple assessment may prove valuable in both research and clinical deliberations. The fact that neither measure (ECOG-PS or GPS) offered prognostic significance during or after treatment in this study probably relates more to the diminished number of evaluable patients at the latter time points. Indeed, it appears by the reported P values that trends were there and with a larger series, these too, might reach significance. However, at the latter points, impairment in performance status or GPS may in some way be confounded by treatment effects and thereby less likely to completely reflect perturbations produced by the underlying disease.
There is a currently developing appreciation of the importance of inflammatory processes at the root of heretofore considered unrelated chronic illnesses including atherosclerosis, diabetes, arthritis, dementia, and cancer. It may turn out that the GPS is of equivalent value for these other conditions as well. n
References
1. Kotler DP. Ann Intern Med. 2000;133:622-634.
2. Scott HR, et al. Br J Cancer. 2002;87:264-267.
3. Forrest LM, et al. Br J Cancer. 2004;90:1704-1706.
The Glasgow Prognostic Score (GPS) is an easily derived measure of underlying inflammatory processes. In this series of 101 patients with newly diagnosed advanced non-small cell lung carcinoma, it proved superior to the ECOG Performance Scale in predicting survival. After initial treatment, however, the prognostic value fell, but this may have been the result of fewer evaluable patients at the latter time points.Subscribe Now for Access
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