Abstract
The Glasgow Prognostic Score (GPS) incorporates C-reactive protein and albumin as clinically useful markers of tumor behavior and shows significant prognostic value in several types of solid tumors. The accuracy of the GPS in predicting outcomes in diffuse large B cell lymphoma (DLBCL) remains unknown. We performed this study to evaluate the prognostic significance of the GPS in DLBCL in China. We retrospectively analyzed 160 patients with newly diagnosed DLBCL at the Shanghai Ruijin Hospital (China). The prognostic value of the GPS was evaluated and compared with that of the International Prognostic Index (IPI) and immunohistochemical subtyping. The GPS was defined as follows: GPS-0, C-reactive protein (CRP) ≤10 mg/L and albumin ≥35 g/L; GPS-1, CRP >10 mg/L or albumin <35 g/L; and GPS-2, CRP >10 mg/L and albumin <35 g/L. Patients with lower GPS tended to have better outcomes including progression-free survival (PFS, P < 0.001) and overall survival (OS, P < 0.001). Multivariate analysis demonstrated that high GPS and high IPI score were independent adverse predictors of OS. Similar to several other tumors, GPS is a reliable predictor of survival outcomes in DLBCL patients treated with R-CHOP therapy. Inflammatory responses are implicated in the progression and survival of patients with DLBCL.
Similar content being viewed by others
References
Alizadeh AA, Eisen MB, Davis RE et al (2000) Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature 403:503–511
Friedberg JW (2008) Diffuse large B-cell lymphoma. Hematol Oncol Clin N Am 22(5):941
Leitch EF, Chakrabarti M, Crozier JE et al (2007) Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer 97:1266–1270
Crumley AB, McMillan DC, McKernan M et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer 94:637–641
Nakagawa K, Tanaka K, Nojiri K et al (2014) The modified Glasgow prognostic score as a predictor of survival after hepatectomy for colorectal liver metastases. Ann Surg Oncol 21(5):1711–1718
Forrest LM, McMillan DC, McArdle CS et al (2003) Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89:1028–1030
Li YJ, Jiang WQ, Huang JJ et al (2013) The Glasgow Prognostic Score (GPS) as a novel and significant predictor of extranodal natural killer/T-cell lymphoma, nasal type. Am J Hematol 88(5):394–399
Hans CP, Weisenburger DD, Greiner TC et al (2004) Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 103:275–282
Ramsey S, Lamb GW, Aitchison M et al (2007) Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer. Cancer 109:205–212
Proctor MJ, Morrison DS, Talwar D et al (2011) A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 47:2633–2641
Li X, Liu Z, Cao J et al (2012) Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in China: a 10-year retrospective follow-up analysis of 437 cases from Shanghai Lymphoma Research Group. Ann Hematol 91(6):837–845
Marnell L, Mold C, Du Clos TW (2005) C-reactive protein: ligands, receptors and role in inflammation. Clin Immunol 117:104–111
Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545
Grivennikov SI, Greten FR, Karin M (2010) Immunity, inflammation, and cancer. Cell 140:883–899
Jiang X, Hiki N, Nunobe S et al (2012) Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer. Br J Cancer 107:275–279
Crumley AB, Stuart RC, McKernan M et al (2010) Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg 34:2393–2398
Ichikawa A, Kinoshita T, Watanabe T et al (1997) Mutations of the p53 gene as a prognostic factor in aggressive B-cell lymphoma. N Engl J Med 337:529–534
Sehn LH, Berry B, Chhanabhai M et al (2007) The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 109(5):1857–1861
Li X, Shen W, Cao J et al (2012) Treatment of gastrointestinal diffuse large B cell lymphoma in China: a 10-year retrospective study of 114 cases. Ann Hematol 91(11):1721–1729
Xia ZG, Xu ZZ, Zhao WL et al (2010) The prognostic value of immunohistochemical subtyping in Chinese patients with de novo diffuse large B-cell lymphoma undergoing CHOP or R-CHOP treatment. Ann Hematol 89(2):171–177
Li QQ, Lu ZH, Yang L et al (2014) Neutrophil count and the inflammation-based Glasgow prognostic score predict survival in patients with advanced gastric cancer receiving first-line chemotherapy. Asian Pac J Cancer Prev 15(2):945–950
Acknowledgments
This work is supported by the Program for Outstanding Young Teachers in Universities of Shanghai, and the Natural Science Foundation of Shanghai (14ZR1425900). We would like to express appreciation to the research assistants for their diligence and attentiveness to detail and the outstanding clinical care delivered by all staffs.
Conflict of interest
The authors declare no competing financial interests.
Author information
Authors and Affiliations
Corresponding author
Additional information
Xiaoyang Li and Yunxiang Zhang contributed equally to this work.
Rights and permissions
About this article
Cite this article
Li, X., Zhang, Y., Zhao, W. et al. The Glasgow Prognostic Score as a significant predictor of diffuse large B cell lymphoma treated with R-CHOP in China. Ann Hematol 94, 57–63 (2015). https://doi.org/10.1007/s00277-014-2167-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-014-2167-0