Inflammation and Performance Status: The Cornerstones of Prognosis in Advanced Cancer

TY - JOUR

T1 - Inflammation and Performance Status

T2 - The Cornerstones of Prognosis in Advanced Cancer

AU - Rocha, Bruna M.M.

AU - Dolan, Ross D.

AU - Paiva, Carlos E.

AU - McGovern, Josh

AU - Paiva, Bianca S.R.

AU - Preto, Daniel D.

AU - McMillan, Donald C.

AU - Maia, Yara C.P.

AU - Laird, Barry J.

N1 - Publisher Copyright: © 2022 American Academy of Hospice and Palliative Medicine

PY - 2023/4

Y1 - 2023/4

N2 - Context: In advanced cancer, although performance status (PS), systemic inflammatory response and nutritional status are known to have prognostic value, geographical variations and sociodemographic indexes may also impact survival. Objectives: This study compares validated prognostic factors in two international cohorts and establishes a prognostic framework for treatment. Methods: Two international biobanks of patients (n=1.518) with advanced cancer were analyzed. Prognostic factors (Eastern Cooperative Oncology Group Performance Status [ECOG-PS], body mass index [BMI] and modified Glasgow Prognostic Score [mGPS]) were assessed. The relationship between these and survival was examined using Kaplan–Meier and Cox regression methods. Results: According to multivariate analysis, in the European cohort the most highly predictive factors were BMI <20 kg/m2 (hazard ratio [HR] 1.644), BMI 20-21.9 kg/m2 (HR 1.347), ECOG-PS (HR 1.597–11.992) and mGPS (HR 1.843–2.365). In the Brazilian cohort, the most highly predictive factors were ECOG-PS (HR 1.678–8.938) and mGPS (HR 2.103–2.837). Considering gastrointestinal cancers in particular (n=551), the survival rate at 3 months in both cohorts together ranged from 93% (mGPS 0, PS 0–1) to 0% (mGPS 2, PS 4), and from 81% (mGPS 0, BMI >28 kg/m2) to 44% (mGPS 2, BMI <20 kg/m2). Conclusion: The established prognostic factors that were compared had similar prognostic capacity in both cohorts. A high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer survival of patients with advanced cancer in the prospective European and Brazilian cohorts.

AB - Context: In advanced cancer, although performance status (PS), systemic inflammatory response and nutritional status are known to have prognostic value, geographical variations and sociodemographic indexes may also impact survival. Objectives: This study compares validated prognostic factors in two international cohorts and establishes a prognostic framework for treatment. Methods: Two international biobanks of patients (n=1.518) with advanced cancer were analyzed. Prognostic factors (Eastern Cooperative Oncology Group Performance Status [ECOG-PS], body mass index [BMI] and modified Glasgow Prognostic Score [mGPS]) were assessed. The relationship between these and survival was examined using Kaplan–Meier and Cox regression methods. Results: According to multivariate analysis, in the European cohort the most highly predictive factors were BMI <20 kg/m2 (hazard ratio [HR] 1.644), BMI 20-21.9 kg/m2 (HR 1.347), ECOG-PS (HR 1.597–11.992) and mGPS (HR 1.843–2.365). In the Brazilian cohort, the most highly predictive factors were ECOG-PS (HR 1.678–8.938) and mGPS (HR 2.103–2.837). Considering gastrointestinal cancers in particular (n=551), the survival rate at 3 months in both cohorts together ranged from 93% (mGPS 0, PS 0–1) to 0% (mGPS 2, PS 4), and from 81% (mGPS 0, BMI >28 kg/m2) to 44% (mGPS 2, BMI <20 kg/m2). Conclusion: The established prognostic factors that were compared had similar prognostic capacity in both cohorts. A high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer survival of patients with advanced cancer in the prospective European and Brazilian cohorts.

KW - Advanced cancer

KW - inflammation

KW - performance status

KW - prognosis

KW - survival analysis

UR - https://www.scopus.com/pages/publications/85146088959

U2 - 10.1016/j.jpainsymman.2022.11.021

DO - 10.1016/j.jpainsymman.2022.11.021

M3 - Article

C2 - 36493981

AN - SCOPUS:85146088959

SN - 0885-3924

VL - 65

SP - 348

EP - 357

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

IS - 4

ER -