Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München.
Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité-Universitaetsmedizin, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg.
ESMO Open. 2024 May;9(5):103374. doi: 10.1016/j.esmoop.2024.103374. Epub 2024 May 13.
The inflammation-based modified Glasgow Prognostic Score (mGPS) combines serum levels of C-reactive protein and albumin and was shown to predict survival in advanced cancer. We aimed to elucidate the prognostic impact of mGPS on survival as well as its predictive value when combined with gender in unselected metastatic colorectal cancer (mCRC) patients receiving first-line chemotherapy in the randomized phase III XELAVIRI trial.
In XELAVIRI, mCRC patients were treated with either fluoropyrimidine/bevacizumab followed by additional irinotecan at first progression (sequential treatment arm; Arm A) or upfront combination of fluoropyrimidine/bevacizumab/irinotecan (intensive treatment arm; Arm B). In the present post hoc analysis, survival was evaluated with respect to the assorted mGPS categories 0, 1 or 2. Interaction between mGPS and gender was analyzed.
Out of 421 mCRC patients treated in XELAVIRI, 362 [119 women (32.9%) and 243 men (67.1%)] were assessable. For the entire study population a significant association between mGPS and overall survival (OS) was observed [mGPS = 0: median 28.9 months, 95% confidence interval (CI) 25.9-33.6 months; mGPS = 1: median 21.4 months, 95% CI 17.6-26.1 months; mGPS = 2: median 16.8 months, 95% CI 14.3-21.2 months; P < 0.00001]. Similar results were found when comparing progression-free survival between groups. The effect of mGPS on survival did not depend on the applied treatment regimen (P = 0.21). In female patients, a trend towards longer OS was observed in Arm A versus Arm B, with this effect being clearly more pronounced in the mGPS cohort 0 (41.6 versus 25.5 months; P = 0.056). By contrast, median OS was longer in male patients with an mGPS of 1-2 treated in Arm B versus Arm A (20.8 versus 17.4 months; P = 0.022).
We demonstrate the role of mGPS as an independent predictor of OS regardless of the treatment regimen in mCRC patients receiving first-line treatment. mGPS may help identify gender-specific subgroups that benefit more or less from upfront intensive therapy.
基于炎症的改良格拉斯哥预后评分（mGPS）结合了血清 C 反应蛋白和白蛋白水平，已被证明可预测晚期癌症患者的生存情况。我们旨在阐明 mGPS 对生存的预后影响，以及在 XELAVIRI 试验中，在接受一线化疗的未经选择的转移性结直肠癌（mCRC）患者中，mGPS 与性别联合时的预测价值。
在 XELAVIRI 中，mCRC 患者接受氟嘧啶/贝伐珠单抗联合后续伊立替康（序贯治疗组；Arm A）或氟嘧啶/贝伐珠单抗/伊立替康联合治疗（强化治疗组；Arm B）。在本事后分析中，根据不同的 mGPS 类别 0、1 或 2 评估生存情况。分析了 mGPS 和性别之间的相互作用。
在 XELAVIRI 中接受治疗的 421 例 mCRC 患者中，362 例（119 名女性[32.9%]和 243 名男性[67.1%]）可评估。对于整个研究人群，mGPS 与总生存（OS）之间存在显著关联[ mGPS=0：中位 OS 28.9 个月，95%置信区间（CI）25.9-33.6 个月；mGPS=1：中位 OS 21.4 个月，95%CI 17.6-26.1 个月；mGPS=2：中位 OS 16.8 个月，95%CI 14.3-21.2 个月；P<0.00001]。在比较各组之间的无进展生存期时，也得到了相似的结果。mGPS 对生存的影响不依赖于应用的治疗方案（P=0.21）。在女性患者中，与 Arm B 相比，Arm A 中观察到 OS 更长的趋势，而在 mGPS 队列 0 中，这种影响更为明显（41.6 与 25.5 个月；P=0.056）。相比之下，mGPS 为 1-2 的男性患者在接受 Arm B 治疗时，OS 较长，而接受 Arm A 治疗时，OS 较短（20.8 与 17.4 个月；P=0.022）。
我们证明了 mGPS 作为 OS 的独立预测因子的作用，无论 mCRC 患者接受一线治疗时的治疗方案如何。mGPS 可能有助于确定从 upfront 强化治疗中获益更多或更少的性别特异性亚组。
