Glasgow Prognostic Score (GPS) Can Be a Useful Indicator to Determine Prognosis of Patients With Colorectal Carcinoma

The Glasgow Prognostic Score (GPS), an inflammation-based score, has been used to predict the biologic behavior of malignant tumors. The aim of the current study was to elucidate a further significance of GPS in colorectal carcinoma. Correlation of GPS and modified GPS (mGPS), which are composed of combined score provided for serum elevation of C-reactive protein and hypoalbuminemia examined before surgical treatment, with clinicopathologic features was investigated in 272 patients with colorectal carcinoma. Survival of GPS 1 patients was significantly worse than that of GPS 0 patients (P= 0.009), and survival of GPS 2 patients was significantly worse than that of GPS 1 patients (P < 0.0001). Similarly, survival of mGPS 1 patients was significantly worse than that of mGPS 0 patients (P = 0.009), and survival of mGPS 2 patients was significantly worse than that of mGPS 1 patients (P = 0.0006). Multivariate analysis demonstrated that GPS (P < 0.0001) as well as tumor stage (P= 0.004) and venous invasion (P = 0.011) were factors independently associated with worse prognosis. Both GPS and mGPS could classify outcome of patients with a clear stratification, and could be applied as prognostic indicators in colorectal carcinoma.Key words: Colorectal carcinoma, Glasgow prognostic score (GPS), Prognostic indicatorAlthough many tumor-environmental elements, including both tumor-related and host-related factors, have been linked with tumor progression, host inflammatory response is one of the more important factors that has a role in the progression and/or development of tumors.¹Serum elevation of C-reactive protein (CRP), an acute phase protein, has been shown to be a prognostic indicator in a variety of neoplasms, including colorectal carcinoma.^2–5 Moreover, hypoalbuminemia brought about by malnutrition and related to cachexic condition has been reported to be correlated with an unfavorable prognosis of some gastrointestinal tumors.^6,7The Glasgow prognostic score (GPS), which is a cumulative inflammation-based cancer-prognostic marker composed of serum elevation of CRP and decrease in albumin concentration, is likely to reflect host systemic inflammatory response and has been reported to be significant as a prognostic indicator in cancer-bearing patients.^8–10Moreover, it has been found that hypoalbuminemia alone is unlikely to be associated with reduced survival likelihood in patients with colorectal carcinoma¹¹; therefore, the GPS has been modified (mGPS), providing a score of 1 only for a case with serum elevation of CRP, and score of 0 for a case only with hypoalbuminemia or where neither was elevated. Although, until now, there have been some reports regarding the significance of GPS as a prognostic indicator in colorectal carcinoma,^9,11–16 the aim of this study was to elucidate further the significance of GPS and mGPS in colorectal carcinoma.