Optimization of the systemic inflammation‐based Glasgow Prognostic Score

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Abstract
BACKGROUND: The modified Glasgow Prognostic Score (mGPS), an inflammation‐based prognostic score that uses thresholds of C‐reactive protein (> 10 mg/L) and albumin (< 35 g/L), has been found to be independently prognostic of survival in patients with cancer. The objective of the current study was to establish whether the addition of a differential leukocyte count and a high‐sensitivity C‐reactive protein measurement enhanced the prognostic value of the mGPS.METHODS: A total of 12,119 patients who had an incidental blood sample taken between 2000 and 2007 for C‐reactive protein, albumin, and a differential leukocyte count as well as a diagnosis of cancer made within 2 years were identified. This group was studied for the prognostic value of neutrophil, lymphocyte, and platelet counts. In addition 2742 patients whose blood was sampled after the introduction of high‐sensitivity C‐reactive protein measurements were studied for the prognostic value of different thresholds.RESULTS: Using cancer‐specific survival as an endpoint, the prognostic value of the mGPS (hazard ratio [HR], 2.61; P < .001 [area under the receiver operating characteristic curve (AUC), 0.695]) was found to be improved by the addition of neutrophil and platelet counts (HR, 4.86; P < .001 [AUC, 0.734]) and a high‐sensitivity C‐reactive protein measurement (> 3 mg/L) (HR, 5.77; P < .001 [AUC, 0.734]).CONCLUSIONS: The results of the current study demonstrate that the addition of neutrophil and platelet counts, as well as a high‐sensitivity C‐reactive protein measurement, enhanced the prognostic value of the mGPS. Cancer 2013;119:2325–2332. © 2013 American Cancer Society.

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