Systemic Inflammation, Survival of Prostate Cancer Patients
Background There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer; however, it is unclear whether this is independent of grade. We therefore investigated the role of inflammation-based prognostic scores, the modified Glasgow Prognostic Score (mGPS) and neutrophil lymphocyte ratio (NLR), and their associations with Gleason grade in patients with prostate cancer.
Methods: Patients from a cohort, the Glasgow Inflammation Outcome Study, who had diagnosis of prostate cancer, were included in this study. The mGPS was constructed by combining C-reactive protein and albumin whereas NLR by calculating the ratio of neutrophils to lymphocytes. We estimated 5-year relative survival and relative excess risk (RER) of death by mGPS and NLR categories after adjusting for age, socioeconomic circumstances and Gleason grade.
Results: In all, 897 prostate cancer patients were identified; of those 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation appeared to have significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socioeconomic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: RER =2.41, 95% confidence interval 1.37–4.23) among aggressive, clinically significant prostate cancer (Gleason grades 8–10).
Conclusions The mGPS is a strong measure of systemic inflammation, when compared with NLR. Prostate cancer patients with a raised mGPS had significantly higher risk of death for overall as well high-grade disease. Inflammation-based prognostic scores predict outcome in patients with prostate cancer and should be added to their routine clinical assessment.
Prostate cancer has now become the most frequently diagnosed cancer among men in Europe, with an estimated 382 000 new cases in 2008. Age-standardised rates have increased rapidly over the past two decades in Europe and the United Kingdom, partly because of the increased use of PSA testing and detection of a asymptomatic disease.
Although survival in patients with prostate cancer has improved in recent years, it is often difficult to differentiate patients who require potentially curative treatment from those who can be managed conservatively. Considerable effort has gone into identifying novel genetic and immunological biomarkers, however, these remain time consuming and not validated to be part of routine clinical practice. Therefore, in general, current clinical decisions are based on readily available tumour-related factors, including PSA levels, Gleason grade and clinical stage.
Although it is recognised that the development of cancer has a genetic basis, there is increasing recognition that the host inflammatory response is associated with the development and progression of cancers. In particular the systemic inflammatory response, as evidenced by an elevated C-reactive protein, has been shown to be independently associated with poor prognosis in many common solid tumours. It is therefore of interest that the systemic inflammatory response, as measured by the modified Glasgow Prognostic Score (mGPS; a combination of C-reactive protein and albumin), has been shown to have prognostic value in operable and non-operable cancers independent of site. It is also of interest that haematological components of the systemic inflammatory response, a combination of circulating neutrophil and lymphocyte counts to form the neutrophil lymphocyte ratio (NLR), have also been shown to be associated with survival in patients with cancer.
The natural history and progression of prostate cancer is poorly understood, however, some evidence suggests an association between the activation of the systemic inflammatory response, as evidenced by raised C-reactive protein concentrations, and survival in patients with prostate cancer. However, these studies were small and it is unclear if these relationships remain in a large cohort, independent of Gleason grade, socioeconomic status and time of sampling. Therefore, the aim of the present study was to investigate the associations between inflammation-based prognostic scores (mGPS and NLR) and survival in a large cohort of patients with prostate cancer.
Abstract and Introduction
Abstract
Background There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer; however, it is unclear whether this is independent of grade. We therefore investigated the role of inflammation-based prognostic scores, the modified Glasgow Prognostic Score (mGPS) and neutrophil lymphocyte ratio (NLR), and their associations with Gleason grade in patients with prostate cancer.
Methods: Patients from a cohort, the Glasgow Inflammation Outcome Study, who had diagnosis of prostate cancer, were included in this study. The mGPS was constructed by combining C-reactive protein and albumin whereas NLR by calculating the ratio of neutrophils to lymphocytes. We estimated 5-year relative survival and relative excess risk (RER) of death by mGPS and NLR categories after adjusting for age, socioeconomic circumstances and Gleason grade.
Results: In all, 897 prostate cancer patients were identified; of those 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation appeared to have significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socioeconomic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: RER =2.41, 95% confidence interval 1.37–4.23) among aggressive, clinically significant prostate cancer (Gleason grades 8–10).
Conclusions The mGPS is a strong measure of systemic inflammation, when compared with NLR. Prostate cancer patients with a raised mGPS had significantly higher risk of death for overall as well high-grade disease. Inflammation-based prognostic scores predict outcome in patients with prostate cancer and should be added to their routine clinical assessment.
Introduction
Prostate cancer has now become the most frequently diagnosed cancer among men in Europe, with an estimated 382 000 new cases in 2008. Age-standardised rates have increased rapidly over the past two decades in Europe and the United Kingdom, partly because of the increased use of PSA testing and detection of a asymptomatic disease.
Although survival in patients with prostate cancer has improved in recent years, it is often difficult to differentiate patients who require potentially curative treatment from those who can be managed conservatively. Considerable effort has gone into identifying novel genetic and immunological biomarkers, however, these remain time consuming and not validated to be part of routine clinical practice. Therefore, in general, current clinical decisions are based on readily available tumour-related factors, including PSA levels, Gleason grade and clinical stage.
Although it is recognised that the development of cancer has a genetic basis, there is increasing recognition that the host inflammatory response is associated with the development and progression of cancers. In particular the systemic inflammatory response, as evidenced by an elevated C-reactive protein, has been shown to be independently associated with poor prognosis in many common solid tumours. It is therefore of interest that the systemic inflammatory response, as measured by the modified Glasgow Prognostic Score (mGPS; a combination of C-reactive protein and albumin), has been shown to have prognostic value in operable and non-operable cancers independent of site. It is also of interest that haematological components of the systemic inflammatory response, a combination of circulating neutrophil and lymphocyte counts to form the neutrophil lymphocyte ratio (NLR), have also been shown to be associated with survival in patients with cancer.
The natural history and progression of prostate cancer is poorly understood, however, some evidence suggests an association between the activation of the systemic inflammatory response, as evidenced by raised C-reactive protein concentrations, and survival in patients with prostate cancer. However, these studies were small and it is unclear if these relationships remain in a large cohort, independent of Gleason grade, socioeconomic status and time of sampling. Therefore, the aim of the present study was to investigate the associations between inflammation-based prognostic scores (mGPS and NLR) and survival in a large cohort of patients with prostate cancer.
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