Qi Feng, Xu Yunqiu, Zheng Yuxiao, Li Xiao, Gao Yang
Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Ann Transl Med. 2019 Oct;7(20):531. doi: 10.21037/atm.2019.09.160.
The prognostic role of Glasgow prognostic score (GPS) or modified GPS (mGPS) in various cancers has been investigated. However, no unified conclusion could be drawn in urological cancers. So, we aimed to explore the potential role of GPS/mGPS in urological cancers.
Related studies were searched from PubMed, Web of Science and Embase up to May 30th, 2019 comprehensively. Their associations were assessed by the pooled hazard ratios (HRs) with its 95% confidence intervals (CIs).
A total of 20 related studies were enrolled in this meta-analysis. The outcomes revealed that a relatively lower level of pre-treatment GPS/mGPS was associated with better overall survival (OS), cancer specific survival (CSS)/disease-specific survival (DSS) and disease-free survival (DFS)/progress-free survival (PFS)/recurrence-free survival (RFS) (pooled HR =2.70; 95% CI, 1.81-4.01; pooled HR =2.90; 95% CI, 2.00-4.22; pooled HR =2.43; 95% CI, 1.62-3.66, respectively). Subgroup analysis by cancer type for OS indicated that GPS/mGPS could also be a predictor no matter in renal cell cancer (RCC) or bladder cancer (BC) (pooled HR =3.60; 95% CI, 2.07-6.28 and pooled HR =2.71; 95% CI, 1.08-6.82). Similar results could be found in CSS/DSS (RCC: HR =4.12; 95% CI, 2.69-6.30) and in DFS/ PFS/RFS (RCC: HR =2.66; 95% CI, 1.82-3.90 and BC: HR =1.52; 95% CI, 1.23-1.88). As for the treatment subgroup, pre-treatment GPS/mGPS played an independent role in OS for patients no matter in which treatment type (Surgery: pooled HR =2.16; 95% CI, 1.43-3.26; Chemotherapy: pooled HR =4.41; 95% CI, 2.27-8.58); the same in CSS/DSS (Surgery: pooled HR =3.28; 95% CI, 1.73-6.20; Immunotherapy: pooled HR =2.72; 95% CI, 1.87-3.96) and DFS/RFS/PFS (Surgery: pooled HR =2.54; 95% CI, 1.65-3.92). Lastly, both GPS and mGPS played prognostic role in OS, CSS/DSS or DFE/RFS/PFS (OS: GPS: pooled HR =2.12; 95% CI, 1.04-4.32; mGPS: pooled HR =3.12; 95% CI, 1.87-5.20; CSS/DSS: GPS: pooled HR =2.87; 95% CI, 2.11-3.91; mGPS: pooled HR =3.00; 95% CI, 1.60-5.63; DFS/RFS/PFS: GPS: pooled HR =3.61; 95% CI, 1.43-9.07; mGPS: pooled HR =1.99; 95% CI, 1.32-2.99).
This study shed light on that GPS/mGPS might be an independent prognostic factor in urological cancers, indicating that a lower level of pre-treatment GPS/mGPS was closely related to better survival outcomes.
格拉斯哥预后评分（GPS）或改良GPS（mGPS）在各种癌症中的预后作用已得到研究。然而，在泌尿系统癌症中尚未得出统一结论。因此，我们旨在探讨GPS/mGPS在泌尿系统癌症中的潜在作用。
截至2019年5月30日，全面检索PubMed、科学网和Embase中的相关研究。通过合并风险比（HRs）及其95%置信区间（CIs）评估它们之间的关联。
本荟萃分析共纳入20项相关研究。结果显示，治疗前较低水平的GPS/mGPS与更好的总生存期（OS）、癌症特异性生存期（CSS）/疾病特异性生存期（DSS）和无病生存期（DFS）/无进展生存期（PFS）/无复发生存期（RFS）相关（合并HR = 2.70；95% CI，1.81 - 4.01；合并HR = 2.90；95% CI，2.00 - 4.22；合并HR = 2.43；95% CI，1.62 - 3.66）。按癌症类型对OS进行亚组分析表明，无论在肾细胞癌（RCC）还是膀胱癌（BC）中，GPS/mGPS都可能是一个预测指标（合并HR = 3.60；95% CI，2.07 - 6.28和合并HR = 2.71；95% CI，1.08 - 6.82）。在CSS/DSS（RCC：HR = 4.12；95% CI，2.69 - 6.30）和DFS/PFS/RFS（RCC：HR = 2.66；95% CI，1.82 - 3.90和BC：HR = 1.52；95% CI，1.23 - 1.88）中也发现了类似结果。至于治疗亚组，无论患者接受何种治疗类型，治疗前的GPS/mGPS在OS中都发挥着独立作用（手术：合并HR = 2.16；95% CI，1.43 - 3.26；化疗：合并HR = 4.41；95% CI，2.27 - 8.58）；在CSS/DSS中也是如此（手术：合并HR = 3.28；95% CI，1.73 - 6.20；免疫治疗：合并HR = 2.72；95% CI，1.87 - 3.96）以及DFS/RFS/PFS（手术：合并HR = 2.54；95% CI，1.65 - 3.92）。最后，GPS和mGPS在OS、CSS/DSS或DFS/RFS/PFS中均发挥预后作用（OS：GPS：合并HR = 2.12；95% CI，1.04 - 4.32；mGPS：合并HR = 3.12；95% CI，1.87 - 5.20；CSS/DSS：GPS：合并HR =
