Glasgow prognostic score is an independent marker for poor prognosis with all cases of epithelial ovarian cancer

Many ways, one destination: a comprehensive review of screening and assessment tools to detect malnutrition in patients with ovarian cancer

Malnutrition is a condition of deficiency, imbalance, or excess in a person's intake of energy and/or nutrients. Despite being common in patients with cancer, it is rarely diagnosed and managed by oncologists. Weight loss or changes in body mass index may fail to capture nutritional risk in patients with ovarian cancer due to masking ascites. The European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition guidelines recommend that patients with cancer undergo formal malnutrition screening and a full specialist assessment for those identified as high risk, and this recommendation is endorsed by European Society of Gynecologic Oncology and National Comprehensive Cancer Network for patients with ovarian cancer. The goal of this review was to describe the most common screening and assessment tools, studied in patients with ovarian cancer, as they relate to patient outcomes (complications, toxicity, and survival). Several tools have been tested in research and clinical settings, including serum markers, algorithms, scores, and clinical screening and assessment methods. These include but are not limited to pre-operative albumin, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, the Glasgow prognostic score, the prognostic nutritional index, and several clinical questionnaires. There are benefits and limitations to any individual tool as described in the review. Emerging technologies may also prove useful for malnutrition detection. We advocate that gynecologic oncology practices adopt a universal standardized method of screening and assessment for malnutrition in patients with ovarian cancer. Malnutrition can dramatically impact oncologic outcomes and patient well-being. Patients with malnutrition should be offered a nutritional care plan. These patients might also benefit from pre-habilitation, an emerging concept in gynecologic oncology, but evidence on its real impact is still limited. It is imperative that future research focus on strategies to reduce nutritional risk, improve patient overall health, and support resilience to cancer and anticancer treatment.

The Influence of Inflammatory and Nutritional Status on the Long-Term Outcomes in Advanced Stage Ovarian Cancer

BACKGROUND

Despite improving surgical techniques and achieving more often complete debulking procedures, certain patients with advanced-stage ovarian cancer still have a very poor prognosis. The aim of the current paper is to investigate whether inflammatory and nutritional status can predict the long-term outcomes of ovarian cancer patients.

METHODS

A retrospective analysis of 57 cases diagnosed with advanced-stage ovarian cancer submitted to surgery as first intent therapy was carried out. In all cases, the preoperative status was determined by calculating the CRP/albumin ratio, as well as the Glasgow score, the modified Glasgow score and the prognostic nutritional index.

RESULTS

Patients presenting higher values of the CRP/albumin ratio, with a higher Glasgow score, modified Glasgow score and prognostic nutritional index (PNI), were more frequently associated with incomplete debulking surgery, a higher peritoneal carcinomatosis index and poorer overall survival (20 months versus 9 months for the CRP/albumin ratio p = 0.011, 42 versus 27 versus 12 months for the Glasgow score p = 0.042, 50 versus 19 versus 12 months for the modified Glasgow score, p = 0.001, and 54 months versus 21 months, p = 0.011 for the prognostic nutritional index).

CONCLUSIONS

A strong relationship between the nutritional and inflammatory status in advanced-stage ovarian cancer seems to exist.

The Prognosis Predictive Score around Neo Adjuvant Chemotherapy (PPSN) Improves Diagnostic Efficacy in Predicting the Prognosis of Epithelial Ovarian Cancer Patients

BACKGROUND

Recent studies have shown that pretreatment inflammatory responses can predict prognosis. However, no reports have analyzed the combined effect of the inflammatory response with pre-treatment and post-neo adjuvant chemotherapy (NACT). This retrospective study aims to identify factors predicting prognosis and create a novel predictive scoring system.

METHODS

The study was conducted at our institution between June 2006 and March 2020. Demographic and clinicopathological data were collected from patients with advanced epithelial ovarian cancer who underwent neoadjuvant chemotherapy after sample collection by laparoscopic or laparotomy surgery, followed by interval debulking surgery. We created a scoring system, called the Predictive Prognosis Score around NACT (PPSN), using factors extracted from a receiver operating characteristic curve analysis. Univariate and multivariate analyses were conducted to assess the efficacy of PPSN in predicting progression-free survival and overall survival. Kaplan-Meier and log-rank tests were used to compare the PFS or OS rate.

RESULTS

Our study included 72 patients, with a cut-off value of four for the scoring system. Our analysis showed that high PPSN (≥4) significantly predicts poor prognosis. Moreover, CD3+ and CD8+ tumor-infiltrating lymphocytes with low PPSN (<4) showed higher aggregation than those with high PPSN (≥4) cases.

CONCLUSION

Our study shows that PPSN could be a useful prognostic tool for advanced EOC patients who undergo NACT followed by IDS.

The prognosis predictive score around primary debulking surgery (PPSP) improves diagnostic efficacy in predicting the prognosis of ovarian cancer

In recent years, the pretreatment inflammatory responses have proven to predict the prognosis, but no report exists analyzing the combined inflammatory response of the pre- and postsurgical treatment. The current study aims to extract the factors predicting the recurrence and create novel predictive scoring. This retrospective study was conducted at our institution between November 2006 and December 2020, with follow-up until September 2022. Demographic and clinicopathological data were collected from women who underwent primary debulking surgery. We created the scoring system named the prognosis predictive score around primary debulking surgery(PPSP) for progression-free survival(PFS). Univariate and multivariate analyses were performed to assess its efficacy in predicting PFS and overall survival(OS). Cox regression analyses were used to assess its time-dependent efficacy. Kaplan-Meier and the log-rank test were used to compare the survival rate. A total of 235 patients were included in the current study. The cut-off value of the scoring system was six. Multivariate analyses revealed that an advanced International Federation of Gynecology and Obstetrics(FIGO) stage (p < 0.001 for PFS; p = 0.038 for OS), the decreased white blood cell count difference (p = 0.026 for PFS) and the high-PPSP (p = 0.004 for PFS; p = 0.002 for OS) were the independent prognostic factors. Cox regression analysis also supported the above results. The PPSP showed good prognostic efficacy not only in predicting the PFS but also OS of ovarian cancer patients comparable to FIGO staging.

Pre-Treatment CRP-Albumin-Lymphocyte Index (CALLY Index) as a Prognostic Biomarker of Survival in Patients with Epithelial Ovarian Cancer

Background

The novel CRP–albumin–lymphocyte (CALLY) index is an improved immunonutritive scoring system, based on serum C-reactive protein (CRP), serum albumin, and the lymphocyte count. It has been determined as a prognostic index for patients with hepatocellular carcinoma. This study was conducted to explore the prognostic value of the CALLY index in patients with epithelial ovarian cancer (EOC) undergoing surgery.

Methods

Patients with EOC treated with surgery as an initial therapy were enrolled to form the training and validation cohorts. The effect of the CALLY index on overall survival (OS) and disease-free survival (DFS) was analyzed using Kaplan–Meier method and Cox proportional hazards model. The CALLY index was calculated as: (Albumin × Lymphocyte)/ (CRP × 10⁴).

Results

There were 190 patients in the training cohort and 120 in the validation cohort, respectively. With a cut-off value of 3, patients were classified into the CALLY <3 and CALLY ≥3 groups. The CALLY index ≥3 was associated with better survival outcomes both in the training and validation cohorts. The univariate and multivariate COX analysis revealed that FIGO stage, lymphatic metastasis, and CALLY index were the prognostic factors for both OS and DFS.

Conclusion

The CALLY index is a novel prognostic biomarker for patients with EOC after surgery. The novel CALLY index could select appropriate patients with poor prognosis for postoperative adjuvant therapy.

Progress in Applicability of Scoring Systems Based on Nutritional and Inflammatory Parameters for Ovarian Cancer

Ovarian cancer is a malignancy that seriously endangers women’s health; its case fatality rate ranks first among the gynecological malignancies. The status of nutrition of ovarian cancer patients is related to their prognoses. Thus, it is important to evaluate, monitor, and improve the nutritional status of ovarian cancer patients during their treatment. Currently, there are several tools for examining malnutrition and nutritional assessment, including NRI (nutrition risk index), PG-SGA (patient-generated subjective global assessment), and NRS 2002 (nutritional risk screening 2002). In addition to malnutrition risk examination and related assessment tools, the evaluation of muscle mass, C-reactive protein, lymphocytes, and other inflammation status indicators, such as neutrophils to lymphocytes ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-albumin ratio, is of great importance. The nutritional status of ovarian cancer patients undergoing surgery affects their postoperative complications and survival rates. Accurate evaluation of perioperative nutrition in ovarian cancer patients is crucial in clinical settings. An intelligent nutritional diagnosis can be developed based on the results of its systematic and comprehensive assessment, which would lay a foundation for the implementation of personalized and precise nutritional therapy.

The Pretreatment Controlling Nutritional Status Score in Ovarian Cancer: Influence on Prognosis, Surgical Outcome, and Postoperative Complication Rate

Introduction The Controlling Nutritional (CONUT) Status score is an established predictor of impaired prognosis in patients with solid tumors. The aim of this study was to investigate the prognostic value of the CONUT score for overall survival and perioperative complication rates in patients with epithelial ovarian cancer.

Patients In this retrospective study we assessed the data of 337 consecutive patients with ovarian cancer. The CONUT score was associated with surgical outcome, postoperative complications and clinicopathological parameters. We used univariate log-rank test and multivariable Cox regression models to evaluate the association between pretreatment CONUT scores and survival.

Results A low CONUT score (0 – 2) was associated with an early FIGO stage (p = 0.004), complete tumor resection (p < 0.001), less neoadjuvant chemotherapy (p = 0.017) and other histologies than serous cystadenocarcinoma (p = 0.006). Postoperative complications were observed in 51.4% and 60.5% of patients with a CONUT score of 0 – 2 and a score > 2, respectively (p = 0.161). A shorter overall survival was observed in patients with a CONUT score > 2 compared to patients with a low CONUT score, with 5-year overall survival rates of 31.5% and 58.7%, respectively (p < 0.001). In multivariable analysis, both advanced age (p < 0.001) and FIGO stage (p < 0.001), residual disease (p < 0.001) and a high CONUT score (p = 0.048) were independently associated with unfavorable overall survival.

Conclusion Pretreatment CONUT score is an independent prognostic marker for overall survival and associated with successful surgery. Patients with a high CONUT score might benefit from pretreatment nutritional intervention.

Prognostic Value of Pretreatment Glasgow Prognostic Score/Modified Glasgow Prognostic Score in Ovarian Cancer: A Systematic Review and Meta-Analysis

To explore prognostic value of pretreatment Glasgow prognostic score (GPS) and modified Glasgow prognostic score (mGPS) in ovarian cancer patients.

The PubMed, EMBASE (via OVID), and Web of Science databases were comprehensively searched for eligible studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to evaluate the association of pretreatment GPS/mGPS with overall survival (OS) and progression-free survival (PFS) of ovarian cancer patients. STATA 12.0 version software was applied for statistical analysis.

A total of eight retrospective studies involving 2260 were included into this systematic review and meta-analysis. The pooled results indicated that patients with elevated pretreatment GPS or mGPS had poorer OS (HR = 1.62, 95% CI: 1.38-1.91, P＜.001) and PFS (HR = 1.40, 95% CI: 1.02-1.93, P = .039) than patients with pretreatment GPS or mGPS 0. Subgroup analysis based on the type of score (GPS or mGPS) and tumor stage for OS were also performed and the results were consistent with above findings.

Pretreatment GPS/mGPS might serve as promising prognostic indexes for ovarian cancer patients. More prospective studies with high-quality are needed to verify our findings.

Baseline nutritional status could be a predictor for radiation esophagitis in esophageal cancer patients undergoing radiotherapy

Background

To investigate the relationship between baseline nutrition status and radiation esophagitis in patients with esophageal cancer treated by radiation therapy.

Methods

A retrospective study was performed on 100 patients with esophageal cancer who was treated with definitive chemoradiotherapy, preoperative chemoradiation and definitive radiotherapy at the Tianjin Medical University Cancer Institute and Hospital from October 2018 and October 2019. We documented the clinical characteristics of patients, including tumor location, clinical stage, treatment, radiation dose, gross tumor volume (GTV), planning tumor volume (PTV) and Atkinson’s Dysphagia score (ADS), and we recorded the nutrition status before radiation, including Patient-Generated Subjective Global Assessment (PG-SGA), body mass index (BMI), weight loss percentage in 3 mouths (WL), the level of albumin (ALB), hemoglobin (HB), C-reactive protein (CRP) and Glasgow prognostic score (GPS). These factors were correlated with radiation esophagitis using univariate and multivariate regression analyses.

Results

Of 100 patients, 44% patients with PG-SGA score ≥9 at baseline, suggesting severe malnutrition, 41% patients developed grade ≥2 radiation esophagitis. In univariate analysis, dose >40 Gy (P=0.015), PTV ≥495 cm³ (P=0.049), PG-SGA score ≥9 (P=0.001), WL ≥10% (P=0.019) and ALB level <35 g/L (P=0.043) were significantly associated with grade ≥2 radiation esophagitis. Multivariate analysis revealed that PG-SGA score ≥9 (P=0.042) was the independent predictor of radiation esophagitis.

Conclusions

Baseline nutritional status associated with development of grade ≥2 radiation esophagitis in patients with esophageal cancer undergoing radiotherapy.

A high Glasgow prognostic score (GPS) or modified Glasgow prognostic score (mGPS) predicts poor prognosis in gynecologic cancers: a systematic review and meta-analysis

PURPOSE

The Glasgow Prognostic Score or modified Glasgow Prognostic Score (GPS/mGPS), a novel inflammatory indicator, which acts as a prognostic predictor in various cancers. However, these results are still controversial. In this meta-analysis, we aimed to investigate the prognostic role of GPS/mGPS in patients with gynecologic cancers.

METHODS

We explored eligible studies by searching the databases PubMed, the Cochrane Library, EMBASE, and Web of Science. The hazard ratio (HR) and odds ratios (OR) with 95% confidence intervals (CIs) were extracted to investigate the correlation between GPS/mGPS and overall survival (OS) and progression-free survival (PFS). Additionally, we performed subgroup analyses to detect the potential heterogeneity in our study.

RESULTS

11 studies involving 2830 patients were enrolled in this meta-analysis. The results revealed that a high GPS was significantly related to a shorter OS (pooled HR = 1.94; 95% CI = 1.54-2.43; P < 0.001) and PFS (pooled HR = 1.92; 95% CI = 1.56-2.35; P < 0.001) in patients with gynecologic cancers. Moreover, mGPS also predicted poor OS (pooled HR = 1.67; 95% CI = 1.41-1.96; P < 0.001) and PFS (pooled HR = 1.73; 95% CI = 1.47-2.04; P < 0.001) in gynecologic cancers patients.

CONCLUSION

A higher GPS/mGPS is correlated with poor survival outcomes in patients with gynecologic cancers. Pretreatment GPS/mGPS is a valid prognostic predictor in gynecologic cancers.

Pre-treatment Glasgow prognostic score and modified Glasgow prognostic score may be potential prognostic biomarkers in urological cancers: a systematic review and meta-analysis

Background

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.

Methods

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).

Results

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).

Conclusions

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.

Pre-treatment psoas major volume is a predictor of poor prognosis for patients with epithelial ovarian cancer

Low skeletal muscle mass (sarcopenia) is an important prognostic risk factor for the outcome of a variety of cancer types. The current study investigated whether skeletal muscle area (SMA), psoas area (PA) and psoas major volume (PV) are associated with progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (OC). A total of 92 OC patients were enrolled in the present study. Pre-treatment with SMA and PA was assessed using computed tomography (CT) and PV was calculated using a three-dimensional-CT (3D-CT). The clinical factors associated with sarcopenia and prognosis were retrospectively evaluated. For all patients, the median PFS and OS were 19 and 32 months, respectively. Patients exhibiting lower PV (<195.6 cm³) had significantly poorer PFS and OS compared with patients exhibiting higher PV (≥195.6 cm³; P=0.018 and P=0.006), while those with low SMA (<92.92 cm²) had significantly worse OS than patients with higher SMA (≥92.92 cm²; P=0.030). PV was also demonstrated to be superior to SMA and PA in prognosis prediction. PV by 3D-CT can serve as an indicator of poor prognosis in patients with OC.

Prognostic Significance of Hematological Markers for Patients with Nasopharyngeal Carcinoma: A Meta-analysis

Purpose: Hematological parameters are considered to be associated with prognosis in various cancers. We designed a meta-analysis to evaluate the prognostic significance of hematological parameters, including the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CRP/ALB), lymphocyte-to-monocyte ratio (LMR), plasma fibrinogen level, Glasgow prognostic score (GPS), platelet-to-lymphocyte ratio (PLR) and high-density lipoprotein cholesterol (HDL-C) level, on clinical outcomes in nasopharyngeal carcinoma (NPC).

Methods: Relevant studies published prior to February 2018 were identified in the PubMed, Web of Science, EMBASE and Cochrane library databases. The primary outcome was overall survival (OS), and the secondary outcome was progression-free survival (PFS). The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.

Results: In total, 23 studies encompassing 23,417 patients were included in our meta-analysis. An elevated NLR was related to a poor OS (HR=1.46, 95% CI=1.30-1.63, p<0.00001) and PFS (HR=1.67, 95% CI=1.36-2.07, p<0.00001), and a high PLR was associated with a poor OS (HR=1.62, 95% CI=1.32-1.98, p<0.00001). Additionally, a high LMR predicted a significantly favorable OS (HR=0.50, 95% CI: 0.43-0.58, p<0.00001). CRP/ALB, the GPS, HDL-C and plasma fibrinogen levels were also related to OS and PFS.

Conclusion: Inflammation-based prognostic scoring systems considering inflammatory cells (lymphocytes, neutrophils, platelets and monocytes) and proteins (ALB, CRP and HDL-C) are essential prognostic factors.

Exosomes derived from hypoxic epithelial ovarian cancer cells deliver microRNAs to macrophages and elicit a tumor-promoted phenotype

Recently, cancer has been considered to be a complex system that includes the tumor microenvironment (TME). Tumor-associated macrophages (TAMs) are the most common immune-related stromal cells in the TME, and communication between cancer cells and TAMs is crucial for the progression of epithelial ovarian cancer (EOC). In this study, we revealed that exosomes derived from EOC cells remodel macrophages to a tumor-promoted phenotype, namely TAMs. In addition, hypoxic microenvironments have been postulated to facilitate this process in the TME, and hypoxia-inducible factors (HIFs) play an important role in this process. We found that TAMs educated by hypoxic exosomes derived from EOC cells promote tumor proliferation and migration in a feedback loop. Based on microarray analysis of normoxic and hypoxic exosomes, we discovered that a panel of miRNAs was enriched in hypoxic exosomes. And these three highly expressed miRNAs were induced by hypoxia via HIFs. In this study, we revealed that under hypoxic conditions, EOC cell-derived exosomes deliver miRNAs to induce M2 macrophage polarization, which promotes EOC cell proliferation and migration. This study suggests that these exosomes and associated miRNAs might serve as targets for novel treatments or diagnostic biomarkers for EOC.

The association between the inflammatory potential of diet and risk of developing, and survival following, a diagnosis of ovarian cancer

PURPOSE

Inflammation has been implicated in ovarian carcinogenesis. This study evaluated two dietary indices: the Dietary Inflammatory Index (DII®) and the Empirical Dietary Inflammatory Pattern (EDIP), in relation to risk of developing, and survival following, a diagnosis of ovarian cancer.

METHODS

Data came from the Australian Ovarian Cancer Study (1375 cases, 1415 population controls). DII and EDIP scores were computed from dietary information obtained using a semiquantitative food-frequency questionnaire. Logistic regression was used to assess the association between DII and EDIP scores and risk of ovarian cancer and proportional hazards models were used for survival analysis.

RESULTS

A high DII score, reflecting a more pro-inflammatory diet, was associated with a modest increased risk of ovarian cancer [odds ratio (OR) DII score_{Q4 vs.Q1} = 1.31, 95% CI 1.06-1.63, p_trend = 0.014]. Likewise a high EDIP score was associated with an increase in risk of ovarian cancer [OR EDIP score_{Q4 vs.Q1} = 1.39, 95% confidence interval (CI) 1.12-1.73, p_trend = 0.002]. We found no association between DII or EDIP score and overall or ovarian cancer-specific survival.

CONCLUSION

In conclusion, our results suggest that a pro-inflammatory diet modestly increases the risk of developing ovarian cancer.

High preoperative Glasgow prognostic score is a negative prognostic factor for patients with endometrial carcinoma

The aim of the present study was to determine the prognostic value of the Glasgow prognostic score (GPS) in endometrial carcinoma (EC). Patients with EC who underwent surgery at the Shimane University Hospital between January 1997 and December 2013 were enrolled (n=118). The associations between pretreatment GPS and clinical parameters, including age, histological type, International Federation of Gynecology and Obstetrics stage, tumor grade, carbohydrate antigen 19-9 and carcinoembryonic antigen levels, progression-free survival (PFS), and overall survival (OS), were investigated. Survival analysis was performed with the Kaplan-Meier method, and prognostic factors were evaluated with Cox's proportional hazards regression model. A high pretreatment GPS was associated with advanced clinical stage, histological type and tumor grade (P<0.001, P=0.007 and P=0.006, respectively). Multivariate analysis identified a high GPS as an independent negative prognostic factor for PFS and OS (P=0.025 and P=0.044, respectively). Therefore, a high pretreatment GPS has prognostic value and the potential to be a predictive marker for surgical outcome in patients with EC. Evaluation of pretreatment GPS may aid in the identification of high-risk populations, which may improve treatment selection and patient outcomes.

Prognostic role of C-reactive protein in patients with nasopharyngeal carcinoma: A meta-analysis and literature review

BACKGROUND

C-reactive protein (CRP) has been shown to be associated with several tumors. However, its association with nasopharyngeal carcinoma (NPC) is not well characterized. We performed a literature review and meta-analysis to assess the prognostic relevance of elevated CRP levels in patients with NPC.

METHODS

A literature search for relevant studies was performed on PubMed (Medline), the Cochrane Library, and Web of Science databases. Hazard ratios (95% confidence intervals) were calculated to assess the association between elevated CRP levels and survival outcomes.

RESULTS

Five studies with a combined study population of 5215 patients with NPC were included. Pooled hazard ratios for overall survival and distant metastasis-free survival were 1.84 (95% CI = 1.57-2.17) and 1.81 (95% CI = 1.53-2.14), respectively. Subgroup analyses showed that types of indicators and treatment before inclusion had no significant impact on the observed association.

CONCLUSION

Elevated serum CRP levels in patients with NPC were associated with worse prognosis.

The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

Background

Inflammation plays an important role in the pathogenesis of ovarian cancer. This study sought to investigate the association between the preoperative c-reactive protein/albumin ratio (CRP/Alb) and oncological outcomes in ovarian cancer patients.

Methods

Two hundred patients with histologically verified ovarian cancer between June 2006 and July 2012 were retrospectively reviewed. Overall survival was evaluated by the Kaplan–Meier method and log-rank test. The significance of risk factors for overall survival was evaluated with the Cox proportional hazards model. Additionally, area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of CRP/Alb, Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI).

Results

The optimal cutoff value of CRP/Alb was 0.68. Increased CRP/Alb (≥0.68) was associated with advanced stage, residual tumor, ascites, elevated serum carbohydrate antigen(CA)-125 level, GPS, and mGPS (all p < 0.05). Patients with high CRP/Alb had poor overall survival compared to those with low CRP/Alb (p < 0.001). Multivariable analysis showed that CRP/Alb (Hazard Ratio (HR) 1.330, 95% confidence interval (CI) 1.131–1.564, p = 0.001), tumor stage (HR 1.577, 95% CI 1.189–2.091, p = 0.002), residual tumor (HR 2.337, 95% CI 1.518–3.597, p < 0.001) and age (HR 1.017, 95% CI 1.000–1.035, p = 0.046) were independent prognostic factors for overall survival. Additionally, the CRP/Alb showed greater AUC values at 1 year (0.692), 3 years (0.659), and 5 years (0.682) than GPS, mGPS and PNI.

Conclusions

The CRP/Alb is a novel independent marker of poor prognosis among ovarian cancer patients and shows superior prognostic ability compared to the established inflammation-based prognostic indices.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3220-x) contains supplementary material, which is available to authorized users.

Prognostic Role of the Pretreatment C-Reactive Protein/Albumin Ratio in Solid Cancers: A Meta-Analysis

The C-reactive protein/albumin ratio (CAR) has been shown to play a significant prognostic role in several cancers. We aimed to comprehensively explore the potential role of the CAR as a prognostic indicator in solid cancers. In this meta-analysis, we collected data from 10 studies that examined the association between serum CAR and overall survival in patients with cancer. This meta-analysis included 4592 tumor patients. The eligible studies were found through the PubMed and Web of Science databases updated on 6 Oct 2016. The pooled hazard ratio (2.01, 95% CI: 1.58–2.56, p < 0.001) indicated that high CAR yielded worse survival in different cancers. Subgroup analyses showed a significant association between CAR and prognosis, regardless of the cutoff value, cutoff value selection, treatment method, country, sample size, stage and cancer type. This meta-analysis suggests that CAR may be a potential prognostic marker in solid cancers. However, further large prospective studies should be conducted to explore the critical role of CAR in survival of cancer patients.

Glasgow prognostic score is an independent marker for poor prognosis with all cases of epithelial ovarian cancer

Inflammatory markers are important prognostic factors in various cancers. This study investigated whether inflammatory markers of the Glasgow prognostic score (GPS) predicted progression‐free survival (PFS) and overall survival (OS) for patients with all cases of epithelial ovarian cancer (OC). Pretreatment GPS was examined for the correlations with PFS and OS in 216 patients in all stages of epithelial OC. Statistical analyses were performed using the Mann–Whitney U‐test. PFS and OS were analyzed using the Kaplan–Meier method. Cox's proportional hazard regression was used for univariate and multivariate analyses. For all patients, the median PFS was 35.1 months, and median OS was 46.7 months; follow‐up range was 1–162 months. Kaplan–Meier analysis revealed that patients with high GPS (GPS 2) at pretreatment had a shorter PFS and OS than did patients with lower GPS (GPS 0 + 1) in for early, advanced, and all‐stages of OC (PFS: P < 0.001 for early‐, advanced‐ and all‐stages; OS; P < 0.001 for early‐ and all‐stage, P = 0.015 for advanced‐stage). GPS (GPS 2) was also found to be an independent predictor of both recurrence (P = 0.002) and survival (P = 0.001) of all cases of epithelial OC by a multivariate analysis. GPS can serve as an indicator of poor prognosis in patients with all stages of epithelial OC, including early‐stage disease and regardless of histology.