Modified Glasgow prognostic score, prognostic nutritional index and ECOG score could be new prognostic factors for survival in metastatic gastric cancer

Abstract

Background: Metastatic gastric carcinoma (MGC) patients usually present with cachexia and sarcopenia. We aimed to analyze the prognostic values of the sarcopenia index (SI), cachexia index (CI) and inflammatory indexes (advanced lung cancer inflammation index [ALI], modified Glasgow Prognostic Score [mGPS], prognostic index [PI], prognostic nutritional index [PNI] and neutrophil-to-lymphocyte ratio [NLR]) on MGC at presentation. Method(s): A retrospective study was performed in 87 patients withMGC. SI, CI, PI, PNI, ALI, mGPS and NLR was measured and calculated appropriately. Due to lack of studies from our country, SI cutoff value has been obtained by using both western (EGWSOP) and eastern (Harada Y, et al) sources separately. Statistical analysis has been done by SPSS. Result(s): Median follow-up time was 9 months (range 1-64) and 78 patients died during follow-up. Fiftynine patients were male (63%) and median age was 62 (23-88). According to univariate analysis these factors had significant negative impact on general survival (GS): increased leukocyte (p=0,003) and neutrophile (p<0,001), decreased lymphocyte count (p=0,048), increased CRP (p<0,001) and decreased serum albumin (p<0,001), high mGPS (p<0,001) and PI score (p<0,001), PNI level <45 (p<0,001), NLR level >= 3,41 (p<0,001), ALI level <18 (p<0,001), CI level under 35 (p<0,001), SI (Harada Y, et al) = 2 (p<0,001), weight loss more than 10% during last 6 months (p=0,002), BMI under 24 (p=0,009). According to multivariable analysis mGPS (HR 2,494, 95% CI 1,25-4,94 p=0,02), PNI (HR 4,2, 95% CI 1,73-10,1 p<0.001) and ECOG score (HR 1,541, 95% CI 1,089-4,214, p=0.004) were independent prognostic factors on GS. mGPS was found to be more valuable than other indexes for predicting mortality. The time consumed during these tests were:mGPS 10 sec, PNI 20 sec, PI 15 sec, NLR 15 sec, ALI 40 sec, CI 17 min, SI 15 min. Conclusion(s): On our study; mGPS, PNI and ECOG score were independent indicators for shorter survival. mGPS and PNI, which can be calculated by using only CRP, albumin levels and complete blood counts, might be inexpensive, practical and beneficial in routine clinical practice.