Skip to main content

Advertisement

SpringerLink
Log in

The Glasgow Prognostic Score as a Predictor of Survival in Patients with Potentially Resectable Pancreatic Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Survival rates after resection of pancreatic adenocarcinoma are poor; however, several tumor-related prognostic factors have been identified. There is increasing evidence that additional patient-related prognostic factors, such as ongoing systemic inflammatory response, are associated with poor outcomes in patients with common solid tumors. The purpose of this study was to evaluate the prognostic significance of the modified glasgow prognostic score (mGPS) in resected pancreatic ductal adenocarcinoma.

Methods

Data were collected from 101 patients who had undergone pancreatic resection for ductal adenocarcinoma. Tumor and host factors were analyzed by Kaplan–Meier and Cox proportional hazard models to evaluate their potential prognostic effects.

Results

An elevated mGPS was associated with lower overall survival rate after pancreatic resection. The median actuarial survival rate for patients with an mGPS of 0, 1, or 2 was 37.2, 11.5, and 7.3, respectively (p = 0.0001). The Cox proportional hazards model, including all the parameters statistically significant at univariate analysis, demonstrated that mGPS, lymph node ratio (LNR), and positive resection margins were independent negative prognostic factors

Conclusions

Margin involvement, LNR, and the preoperative mGPS were identified as independent predictors of survival in patients undergoing potentially curative pancreatic resection. Based on the present results and existing validation literature, the mGPS should be included in the routine assessment of patients with pancreatic cancer to better stratify patients for entry into therapeutic trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. AIRTUM Working Group. Cancer incidence and mortality trends of the Italian Network of Cancer Registries (AIRTUM), 1998–2005. http://www.registri-tumori.it/cms/?q=Doc2009 Rivista dell’Associazione Italiana di Epidemiologia 2009.

  2. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single institution experience. J Gastrointest Surg. 2006;10:1199–210.

    Article  PubMed  Google Scholar 

  3. Brennan MF, Kattan MW, Klimstra D, et al. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.

    Article  PubMed  Google Scholar 

  4. La Torre M, Cavallini M, Ramacciato G, Cosenza G, Del Monte SR, Nigri G, Ferri M, Mercantini P, Ziparo V. Role of the lymph node ratio in pancreatic ductal adenocarcinoma. Impact on patient stratification and prognosis. J Surg Oncol. 2011;104(6):629–33.

    Article  PubMed  Google Scholar 

  5. Colotta F, Allavena P, Sica A, et al. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30:1073–81.

    Article  PubMed  CAS  Google Scholar 

  6. Vakkila J, Lotze MT. Inflammation and necrosis promote tumour growth. Nat Rev Immunol. 2004;4:641–8.

    Article  PubMed  CAS  Google Scholar 

  7. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149–63.

    Article  PubMed  CAS  Google Scholar 

  8. Forrest LM, McMillan DC, McArdle CS, et al. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004;90:1704–6.

    PubMed  CAS  Google Scholar 

  9. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448–54.

    Article  PubMed  CAS  Google Scholar 

  10. McMillan DC, Elahi MM, Sattar N, et al. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer. 2001;41:64–9.

    PubMed  CAS  Google Scholar 

  11. Glen P, Jamieson NB, McMillan DC, et al. Evaluation of an inflammation-based prognostic score in patients with inoperable pancreatic cancer. Pancreatology. 2006;6:450-3.

    Article  PubMed  Google Scholar 

  12. Al Murri AM, Bartlett JM, Canney PA, et al. Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer. 2006;94:227–30.

    Article  PubMed  CAS  Google Scholar 

  13. Jamieson NB, Denley SM, Logue J, et al. A prospective comparison of the prognostic value of tumor- and patient-related factors in patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2011;18(8):2318–28.

    Article  PubMed  Google Scholar 

  14. Sobin LH, Wittekind C. TNM classification of malignant tumours (UICC). 6th ed. New York: John Wiley & Sons; 2002.

    Google Scholar 

  15. Slidell MB, Chang DC, Cameron JL, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008;15(1):165–74.

    Article  PubMed  Google Scholar 

  16. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  17. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–70.

    PubMed  CAS  Google Scholar 

  18. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149–63.

    Article  PubMed  CAS  Google Scholar 

  19. Nozoe T, Korenaga D, Futatsugi M, et al. Immunohistochemical expression of C-reactive protein in squamous cell carcinoma of the esophagus: significance as a tumor marker. Cancer Lett. 2003;192:89–95.

    Article  PubMed  CAS  Google Scholar 

  20. Du Clos TW. Function of C-reactive protein. Ann Med 2000;32:274–8.

    Article  PubMed  Google Scholar 

  21. Legouffe E, Rodriguez C, Picot MC, et al. C-reactive protein serum level is a valuable and simple prognostic marker in non Hodgkin’s lymphoma. Leuk Lymphoma. 1998;31:351–7.

    PubMed  CAS  Google Scholar 

  22. Crumley AB, Stuart RC, McKernan M, et al. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg. 2010;34:2393–8.

    Article  PubMed  Google Scholar 

  23. Lien YC, Hsieh CC, Wu YC, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg. 2004;8:1041–8.

    Article  PubMed  Google Scholar 

  24. Jamieson NB, Glen P, McMillan DC, et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer. 2005;92(1):21–3.

    Article  PubMed  CAS  Google Scholar 

  25. Smith RA, Dajani K, Dodd S, et al. Preoperative resolution of jaundice following biliary stenting predicts more favourable early survival in resected pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2008;15:3138–46.

    Article  PubMed  Google Scholar 

  26. Canna K, McMillan DC, McKee RF, et al. Evaluation of a cumulative prognostic score based on the systemic inflammatory response in patients undergoing potentially curative surgery for colorectal cancer. Br J Cancer. 2004;90:1707–9.

    PubMed  CAS  Google Scholar 

  27. Ikeda M, Natsugoe S, Ueno S, et al. Significant host- and tumor-related factors for predicting prognosis in patients with esophageal carcinoma. Ann Surg. 2003;238:197–202.

    PubMed  Google Scholar 

Download references

Acknowledgement

Marco La Torre is supported by the PhD University Grant program “Clinical and Experimental Research Methodologies in Oncology” provided by the Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy.

Competing interests

The authors declare no potential financial conflict of interest related to this manuscript.

Author information

Authors and Affiliations

  1. Department of General Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy

    Marco La Torre MD, Marco Cavallini MD, Paolo Mercantini MD & Vincenzo Ziparo MD

  2. Department of Hepato-Biliary and Pancreatic Surgery, Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology, University of Rome “La Sapienza”, Rome, Italy

    Giuseppe Nigri MD & Giovanni Ramacciato MD

Authors
  1. Marco La Torre MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Nigri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Cavallini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paolo Mercantini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincenzo Ziparo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Ramacciato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco La Torre MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

La Torre, M., Nigri, G., Cavallini, M. et al. The Glasgow Prognostic Score as a Predictor of Survival in Patients with Potentially Resectable Pancreatic Adenocarcinoma. Ann Surg Oncol 19, 2917–2923 (2012). https://doi.org/10.1245/s10434-012-2348-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2348-9

Keywords

Search

Navigation