Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 7-Day Trial for You or Your Team.

Learn More →

Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer

Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in... Clinical British Journal of Cancer (2004) 90, 1704 – 1706 & 2004 Cancer Research UK All rights reserved 0007 – 0920/04 $25.00 www.bjcancer.com Short Communication Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer 1 ,1 1 1 2 LM Forrest , DC McMillan , CS McArdle , WJ Angerson and DJ Dunlop 1 2 University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK; Department of Medical Oncology, Royal Infirmary, Glasgow G31 2ER, UK The value of an inflammation-based prognostic score (GPS) was compared with performance status (ECOG) in patients (n¼ 109) receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. On multivariate analysis with ECOG, white cell count and the GPS entered as covariates, only the GPS was a significant independent predictor of survival (HR 1.88, 95% CI 1.25– 2.84, P¼ 0.002). British Journal of Cancer (2004) 90, 1704–1706. doi:10.1038/sj.bjc.6601789 www.bjcancer.com Published online 13 April 2004 & 2004 Cancer Research UK Keywords: systemic inflammatory response; prognostic score; stage; performance status; survival; chemotherapy; non-small-cell lung cancer Non-small-cell lung cancer (NSCLC) is the most common cause of MATERIALS AND METHODS cancer death in North America and Western Europe. Most patients Study design present with advanced inoperable disease; the prognosis of these patients is extremely poor. In selected patients, platinum-based Patients presenting with inoperable NSCLC (stages III and IV) to a regimens have been shown to have a beneficial but modest impact single multidisciplinary oncology clinic in Glasgow Royal Infirm- on survival (Klastersky and Paesmans, 2001). Conventionally, the ary between March 2000 and June 2003 were studied prospectively. selection of patients for chemotherapy has been based on clinico- All patients had cytologically or histologically confirmed disease pathological criteria, including age, stage and performance status and were staged on the basis of clinical findings, chest X-ray and, (Numico et al, 2001). where appropriate, bronchoscopy, liver ultrasound, isotope bone There is increasing evidence that the presence of a systemic scan and computerised tomography of the thorax, according to the inflammatory response, as evidenced by elevated circulating American Thoracic Society TNM classification (Mountain, 1991). concentrations of C-reactive protein concentrations, is associated Clinical stage, tumour type and performance status (Eastern with early recurrence and poor survival, independent of stage, in a Cooperative Oncology Group, ECOG) were recorded at the time of variety of common solid tumours (Ikeda et al, 2003; McMillan et al, diagnosis. A blood sample was also obtained for the measurement 2003). In advanced disease, an elevated C-reactive protein has also of white cell count, albumin and C-reactive protein concentrations. been shown to associated with poor survival (O’Gorman et al, Patients received between one and six cycles of platinum-based 2000; Mahmoud and Rivera, 2002). chemotherapy. Furthermore, in an unselected cohort of patients with inoperable The study was approved by the Research Ethics Committee of NSCLC, the Glasgow Prognostic Score (GPS), a cumulative Glasgow Royal Infirmary. prognostic score based on C-reactive protein and albumin, had similar prognostic value to that of stage and performance status Methods (Forrest et al, 2003). The question of whether the GPS would be useful in the selection of appropriate treatment for patients with Blood parameters: Routine laboratory measurements of albumin inoperable NSCLC remains to be determined. and C-reactive protein concentration were carried out. The The aim of the present study was to assess the value of the GPS coefficient of variation for these methods, over the range of in patients receiving chemotherapy for inoperable NSCLC. measurement, was less than 5% as established by routine quality control procedures. The GPS was constructed as previously described (Forrest et al, 2003). Briefly, patients with both an elevated C-reactive protein 1 1 (410 mg l ) and hypoalbuminaemia (o35 g l ) were allocated a *Correspondence: Dr DC McMillan; score of 2. Patients in whom only one of these biochemical E-mail: [email protected] abnormalities was present were allocated a score of 1. Patients in Received 13 November 2003; revised 17 February 2004; accepted 18 whom neither of these abnormalities was present were allocated a February 2004; published online 13 April 2004 score of 0. Inflammation-based prognostic score in lung cancer LM Forrest et al Statistics 1.0 Univariate survival analysis was performed using the Kaplan– 0.9 Meier method with the log-rank test. Multivariate survival analysis 0.8 and calculation of hazard ratios (HR) were performed using Cox regression analysis. Deaths up to 31st October 2003 were included 0.7 in the analysis. Analysis was performed using SPSS software (SPSS Inc., Chicago, IL, USA). 0.6 0.5 0.4 RESULTS 0.3 The characteristics of patients with inoperable NSCLC receiving platinum-based chemotherapy (n¼ 109) are shown in Table 1. The 0.2 majority were male and over the age of 60 years. Approximately 50% had stage III disease, 90% had an ECOG performance status of 0.1 0–1, 75% had an elevated C-reactive protein and 10% had 0.0 hypoalbuminaemia. The majority (68%) received cisplatin-based 0 3 6 912 15 18 chemotherapy and the remainder carboplatin-based chemother- apy. Survival (months) In total, 71 (65%) of patients died during the follow-up period. On univariate survival analysis, both white cell count and GPS B 1.0 were significant predictors of survival. Median survival times in the groups with an ECOG of 0, 1 and 2 were 16, 12 and 7 months, 0.9 respectively, but were associated with wide confidence intervals 0.8 and the difference in survival was not significant (Figure 1A). Median survival times in the groups with a GPS of 0, 1 and 2 were 0.7 17, 12 and 7 months respectively (Po0.01, Figure 1B). On multivariate analysis with ECOG, white cell count and the 0.6 GPS entered as covariates, only the GPS was a significant 0.5 independent predictor of survival (HR 1.88, 95% CI 1.25–2.84, P¼ 0.002). 0.4 0.3 0.2 Table 1 Clinical characteristics and survival in patients with inoperable NSCLC receiving platinum-based chemotherapy: univariate survival analysis 0.1 0.0 Patients Survival (months) P-value 0 3 6 912 15 18 109 (100%) Median (95% CI) Survival (months) Age Figure 1 (A) The relationship between ECOG performance status (0 o60 years 41 (38) 10.6 (3.8 – 17.3) yy., 1 —– , 2 _____) in patients with inoperable non-small-cell lung X60 years 68 (62) 13.5 (11.2 – 15.9) 0.681 cancer receiving platinum-based chemotherapy. (B) The relationship between the GPS (0 yy., 1 —–, 2 _____) in patients with inoperable Sex non-small-cell lung cancer receiving platinum-based chemotherapy. Male 63 (58) 15.1 (11.0 – 19.2) Female 46 (42) 10.6 (10.1 – 11.1) 0.433 Stage III 52 (47) 13.5 (9.1 – 18.0) DISCUSSION IV 57 (52) 12.2 (7.8 – 16.6) 0.337 Conventionally, in patients with inoperable NSCLC, the decision whether or not to offer chemotherapy is primarily based on Type Squamous 40 (37) 15.1 (7.9 – 22.4) performance status. However, the assessment of performance Adenocarcinoma 46 (42) 14.0 (9.5 – 18.6) status is subjective. For example, significant differences in the Other 23 (21) 11.7 (9.7 – 13.6) 0.192 assessment of performance status have been reported between oncologists, nurses and patients, oncologists being the most Performance status (ECOG) optimistic in their assessment and patients the least (Ando et al, 0 29 (27) 16.0 (9.2 – 22.7) 2001). As a result there is continuing interest in the development of 1 71 (65) 12.2 (9.9 – 14.5) prognostic scores, which better reflect clinical outcome (Bennett 2 9 (8) 7.1 (1.7 – 12.4) 0.405 and Ryall, 2000; Sloan et al, 2001). In the present study, an inflammation-based prognostic score White cell count o10 10 /l 62 (56) 16.6 (13.1 – 20.1) based on standard laboratory measurements, the GPS, appeared to Z10 10 /l 47 (44) 11.7 (9.4 – 14.0) 0.029 be superior to performance status in predicting outcome following platinum-based chemotherapy. This may be in part because the GPS assessment of performance status reflects functional status at a 0 27 (25) 17.0 (14.0 – 19.9) specific point in time. In contrast, the GPS, based as it is on the 1 69 (63) 12.1 (10.0 – 14.1) presence of an ongoing systemic inflammatory response and 2 13 (12) 7.1 (4.9 – 9.2) 0.005 hypoalbuminaemia, predicts the progressive nutritional decline of & 2004 Cancer Research UK British Journal of Cancer (2004) 90(9), 1704 – 1706 Cumulative survival Cumulative survival Clinical Clinical Inflammation-based prognostic score in lung cancer LM Forrest et al the patient (McMillan et al, 2001; Scott et al, 2002). Indeed, it has determining the ability of patients to tolerate platinum-based long been recognised that progressive weight loss is associated chemotherapy. with poor tolerance to chemotherapy (Chlebowski et al, 1996; It is possible that in patients with inoperable non-small-lung Paesmans et al, 1997). cancer, an elevated C-reactive protein concentration might reflect More recently, it has been reported that cytochrome P450 3A intercurrent infection. If this were the case it might be expected activity, the principal drug metabolising enzyme in a variety of that the increase in circulating C-reactive protein concentrations chemotherapeutic agents, is compromised in advanced lung cancer would be associated with a rise in the white cell count. However, in patients with an elevated C-reactive protein concentration (Rivory the present study, although the white cell count was significantly et al, 2002; Slaviero et al, 2003). One might therefore postulate that correlated with C-reactive protein concentrations, the magnitude the presence of a systemic inflammatory response would be of the relationship was small (r ¼ 10.6%). This would suggest that associated with increased toxicity in patients receiving platinum- infection was not the main stimulus to the increased C-reactive based chemotherapy. It was therefore of interest that 40% of protein concentrations. patients with a GPS of 0 received six cycles platinum-based The results of the present study suggest that the GPS offers chemotherapy compared with only 9% of those with a GPS of 1 or additional prognostic information that may assist in the selection 2(P¼ 0.003, Fisher’s exact test). This suggests that the presence of of appropriate patients with inoperable NSCLC for platinum-based a systemic inflammatory response may be an important factor in chemotherapy. REFERENCES Ando M, Ando Y, Hasegawa Y, Shimokata K, Minami H, Wakai K, Ohno Y, Mountain CF (1991) A new international staging system for lung cancer. Sakai S (2001) Prognostic value of performance status assessed by Chest 89(Suppl 4): 225s–233s patients themselves, nurses, and oncologists in advanced non-small cell Numico G, Russi E, Merlano M (2001) Best supportive care in non-small lung cancer. Br J Cancer 85: 1634–1639 cell lung cancer: is there a role for radiotherapy and chemotherapy? Lung Bennett M, Ryall N (2000) Using the modified Barthel index to estimate Cancer 32: 213– 226 survival in cancer patients in hospice: observational study. BMJ O’Gorman P, McMillan DC, McArdle CS (2000) Prognostic factors in 321(7273): 1381–1382 advanced gastrointestinal cancer patients with weight loss. Nutr Cancer Chlebowski RT, Palomares MR, Lillington L, Grosvenor M (1996) Recent 37: 36–40 implications of weight loss in lung cancer management. Nutrition 12(1 Paesmans M, Sculier JP, Libert P, Bureau G, Dabouis G, Thiriaux J, Michel Suppl): S43–7 J, Van Cutsem O, Sergysels R, Mommen P, Klastersky J (1997) Response Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ (2003) to chemotherapy has predictive value for further survival of patients with Evaluation of cumulative prognostic scores based on the systemic advanced non-small cell lung cancer: 10 years experience of the inflammatory response in patients with inoperable non-small-cell lung European Lung Cancer Working Party. Eur J Cancer 33: 2326–2332 cancer. Br J Cancer 89: 1028–1030 Rivory LP, Slaviero KA, Clarke SJ (2002) Hepatic cytochrome P450 3A drug Ikeda M, Natsugoe S, Ueno S, Baba M, Aikou T (2003) Significant host- and metabolism is reduced in cancer patients who have an acute-phase tumor-related factors for predicting prognosis in patients with response. Br J Cancer 87: 277–280 esophageal carcinoma. Ann Surg 238: 197– 202 Scott HR, McMillan DC, Forrest LM, Brown DJF, McArdle CS, Milroy R Klastersky J, Paesmans M (2001) Response to chemotherapy, quality of life (2002) The systemic inflammatory response, weight loss, performance benefits and survival in advanced non-small cell lung cancer: review of status and survival in patients with inoperable non-small cell lung literature results. Lung Cancer 34(Suppl 4): S95–S101 cancer. Br J Cancer 87: 264–267 Mahmoud FA, Rivera NI (2002) The role of C-reactive protein as a Slaviero KA, Clarke SJ, Rivory LP (2003) Inflammatory response: prognostic indicator in advanced cancer. Curr Oncol Rep 4: 250–255 an unrecognised source of variability in the pharmacokinetics McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory and pharmacodynamics of cancer chemotherapy. Lancet Oncol 4: response predicts survival following curative resection of colorectal 224–232 cancer. Br J Surg 90: 215–219 Sloan JA, Loprinzi CL, Laurine JA, Novotny PJ, Vargas-Chanes D, Krook JE, McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS O’Connell MJ, Kugler JW, Tirona MT, Kardinal CG, Wiesenfeld M, (2001) Albumin concentrations are primarily determined by the body Tschetter LK, Hatfield AK, Schaefer PL (2001) A simple stratification cell mass and the systemic inflammatory response in cancer patients with factor prognostic for survival in advanced cancer: the good/bad/ weight loss. Nutr Cancer 39: 210–213 uncertain index. J Clin Oncol 19: 3539–3546 British Journal of Cancer (2004) 90(9), 1704 – 1706 & 2004 Cancer Research UK http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png British Journal of Cancer Springer Journals

Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer

Download PDF
3 pages

Loading next page...
 
/lp/springer-journals/comparison-of-an-inflammation-based-prognostic-score-gps-with-aNKsKflNBq

References (34)

Publisher
Springer Journals
Copyright
Copyright © 2004 by The Author(s)
Subject
Biomedicine; Biomedicine, general; Cancer Research; Epidemiology; Molecular Medicine; Oncology; Drug Resistance
ISSN
0007-0920
eISSN
1532-1827
DOI
10.1038/sj.bjc.6601789
Publisher site
See Article on Publisher Site

Abstract

Clinical British Journal of Cancer (2004) 90, 1704 – 1706 & 2004 Cancer Research UK All rights reserved 0007 – 0920/04 $25.00 www.bjcancer.com Short Communication Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer 1 ,1 1 1 2 LM Forrest , DC McMillan , CS McArdle , WJ Angerson and DJ Dunlop 1 2 University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK; Department of Medical Oncology, Royal Infirmary, Glasgow G31 2ER, UK The value of an inflammation-based prognostic score (GPS) was compared with performance status (ECOG) in patients (n¼ 109) receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. On multivariate analysis with ECOG, white cell count and the GPS entered as covariates, only the GPS was a significant independent predictor of survival (HR 1.88, 95% CI 1.25– 2.84, P¼ 0.002). British Journal of Cancer (2004) 90, 1704–1706. doi:10.1038/sj.bjc.6601789 www.bjcancer.com Published online 13 April 2004 & 2004 Cancer Research UK Keywords: systemic inflammatory response; prognostic score; stage; performance status; survival; chemotherapy; non-small-cell lung cancer Non-small-cell lung cancer (NSCLC) is the most common cause of MATERIALS AND METHODS cancer death in North America and Western Europe. Most patients Study design present with advanced inoperable disease; the prognosis of these patients is extremely poor. In selected patients, platinum-based Patients presenting with inoperable NSCLC (stages III and IV) to a regimens have been shown to have a beneficial but modest impact single multidisciplinary oncology clinic in Glasgow Royal Infirm- on survival (Klastersky and Paesmans, 2001). Conventionally, the ary between March 2000 and June 2003 were studied prospectively. selection of patients for chemotherapy has been based on clinico- All patients had cytologically or histologically confirmed disease pathological criteria, including age, stage and performance status and were staged on the basis of clinical findings, chest X-ray and, (Numico et al, 2001). where appropriate, bronchoscopy, liver ultrasound, isotope bone There is increasing evidence that the presence of a systemic scan and computerised tomography of the thorax, according to the inflammatory response, as evidenced by elevated circulating American Thoracic Society TNM classification (Mountain, 1991). concentrations of C-reactive protein concentrations, is associated Clinical stage, tumour type and performance status (Eastern with early recurrence and poor survival, independent of stage, in a Cooperative Oncology Group, ECOG) were recorded at the time of variety of common solid tumours (Ikeda et al, 2003; McMillan et al, diagnosis. A blood sample was also obtained for the measurement 2003). In advanced disease, an elevated C-reactive protein has also of white cell count, albumin and C-reactive protein concentrations. been shown to associated with poor survival (O’Gorman et al, Patients received between one and six cycles of platinum-based 2000; Mahmoud and Rivera, 2002). chemotherapy. Furthermore, in an unselected cohort of patients with inoperable The study was approved by the Research Ethics Committee of NSCLC, the Glasgow Prognostic Score (GPS), a cumulative Glasgow Royal Infirmary. prognostic score based on C-reactive protein and albumin, had similar prognostic value to that of stage and performance status Methods (Forrest et al, 2003). The question of whether the GPS would be useful in the selection of appropriate treatment for patients with Blood parameters: Routine laboratory measurements of albumin inoperable NSCLC remains to be determined. and C-reactive protein concentration were carried out. The The aim of the present study was to assess the value of the GPS coefficient of variation for these methods, over the range of in patients receiving chemotherapy for inoperable NSCLC. measurement, was less than 5% as established by routine quality control procedures. The GPS was constructed as previously described (Forrest et al, 2003). Briefly, patients with both an elevated C-reactive protein 1 1 (410 mg l ) and hypoalbuminaemia (o35 g l ) were allocated a *Correspondence: Dr DC McMillan; score of 2. Patients in whom only one of these biochemical E-mail: [email protected] abnormalities was present were allocated a score of 1. Patients in Received 13 November 2003; revised 17 February 2004; accepted 18 whom neither of these abnormalities was present were allocated a February 2004; published online 13 April 2004 score of 0. Inflammation-based prognostic score in lung cancer LM Forrest et al Statistics 1.0 Univariate survival analysis was performed using the Kaplan– 0.9 Meier method with the log-rank test. Multivariate survival analysis 0.8 and calculation of hazard ratios (HR) were performed using Cox regression analysis. Deaths up to 31st October 2003 were included 0.7 in the analysis. Analysis was performed using SPSS software (SPSS Inc., Chicago, IL, USA). 0.6 0.5 0.4 RESULTS 0.3 The characteristics of patients with inoperable NSCLC receiving platinum-based chemotherapy (n¼ 109) are shown in Table 1. The 0.2 majority were male and over the age of 60 years. Approximately 50% had stage III disease, 90% had an ECOG performance status of 0.1 0–1, 75% had an elevated C-reactive protein and 10% had 0.0 hypoalbuminaemia. The majority (68%) received cisplatin-based 0 3 6 912 15 18 chemotherapy and the remainder carboplatin-based chemother- apy. Survival (months) In total, 71 (65%) of patients died during the follow-up period. On univariate survival analysis, both white cell count and GPS B 1.0 were significant predictors of survival. Median survival times in the groups with an ECOG of 0, 1 and 2 were 16, 12 and 7 months, 0.9 respectively, but were associated with wide confidence intervals 0.8 and the difference in survival was not significant (Figure 1A). Median survival times in the groups with a GPS of 0, 1 and 2 were 0.7 17, 12 and 7 months respectively (Po0.01, Figure 1B). On multivariate analysis with ECOG, white cell count and the 0.6 GPS entered as covariates, only the GPS was a significant 0.5 independent predictor of survival (HR 1.88, 95% CI 1.25–2.84, P¼ 0.002). 0.4 0.3 0.2 Table 1 Clinical characteristics and survival in patients with inoperable NSCLC receiving platinum-based chemotherapy: univariate survival analysis 0.1 0.0 Patients Survival (months) P-value 0 3 6 912 15 18 109 (100%) Median (95% CI) Survival (months) Age Figure 1 (A) The relationship between ECOG performance status (0 o60 years 41 (38) 10.6 (3.8 – 17.3) yy., 1 —– , 2 _____) in patients with inoperable non-small-cell lung X60 years 68 (62) 13.5 (11.2 – 15.9) 0.681 cancer receiving platinum-based chemotherapy. (B) The relationship between the GPS (0 yy., 1 —–, 2 _____) in patients with inoperable Sex non-small-cell lung cancer receiving platinum-based chemotherapy. Male 63 (58) 15.1 (11.0 – 19.2) Female 46 (42) 10.6 (10.1 – 11.1) 0.433 Stage III 52 (47) 13.5 (9.1 – 18.0) DISCUSSION IV 57 (52) 12.2 (7.8 – 16.6) 0.337 Conventionally, in patients with inoperable NSCLC, the decision whether or not to offer chemotherapy is primarily based on Type Squamous 40 (37) 15.1 (7.9 – 22.4) performance status. However, the assessment of performance Adenocarcinoma 46 (42) 14.0 (9.5 – 18.6) status is subjective. For example, significant differences in the Other 23 (21) 11.7 (9.7 – 13.6) 0.192 assessment of performance status have been reported between oncologists, nurses and patients, oncologists being the most Performance status (ECOG) optimistic in their assessment and patients the least (Ando et al, 0 29 (27) 16.0 (9.2 – 22.7) 2001). As a result there is continuing interest in the development of 1 71 (65) 12.2 (9.9 – 14.5) prognostic scores, which better reflect clinical outcome (Bennett 2 9 (8) 7.1 (1.7 – 12.4) 0.405 and Ryall, 2000; Sloan et al, 2001). In the present study, an inflammation-based prognostic score White cell count o10 10 /l 62 (56) 16.6 (13.1 – 20.1) based on standard laboratory measurements, the GPS, appeared to Z10 10 /l 47 (44) 11.7 (9.4 – 14.0) 0.029 be superior to performance status in predicting outcome following platinum-based chemotherapy. This may be in part because the GPS assessment of performance status reflects functional status at a 0 27 (25) 17.0 (14.0 – 19.9) specific point in time. In contrast, the GPS, based as it is on the 1 69 (63) 12.1 (10.0 – 14.1) presence of an ongoing systemic inflammatory response and 2 13 (12) 7.1 (4.9 – 9.2) 0.005 hypoalbuminaemia, predicts the progressive nutritional decline of & 2004 Cancer Research UK British Journal of Cancer (2004) 90(9), 1704 – 1706 Cumulative survival Cumulative survival Clinical Clinical Inflammation-based prognostic score in lung cancer LM Forrest et al the patient (McMillan et al, 2001; Scott et al, 2002). Indeed, it has determining the ability of patients to tolerate platinum-based long been recognised that progressive weight loss is associated chemotherapy. with poor tolerance to chemotherapy (Chlebowski et al, 1996; It is possible that in patients with inoperable non-small-lung Paesmans et al, 1997). cancer, an elevated C-reactive protein concentration might reflect More recently, it has been reported that cytochrome P450 3A intercurrent infection. If this were the case it might be expected activity, the principal drug metabolising enzyme in a variety of that the increase in circulating C-reactive protein concentrations chemotherapeutic agents, is compromised in advanced lung cancer would be associated with a rise in the white cell count. However, in patients with an elevated C-reactive protein concentration (Rivory the present study, although the white cell count was significantly et al, 2002; Slaviero et al, 2003). One might therefore postulate that correlated with C-reactive protein concentrations, the magnitude the presence of a systemic inflammatory response would be of the relationship was small (r ¼ 10.6%). This would suggest that associated with increased toxicity in patients receiving platinum- infection was not the main stimulus to the increased C-reactive based chemotherapy. It was therefore of interest that 40% of protein concentrations. patients with a GPS of 0 received six cycles platinum-based The results of the present study suggest that the GPS offers chemotherapy compared with only 9% of those with a GPS of 1 or additional prognostic information that may assist in the selection 2(P¼ 0.003, Fisher’s exact test). This suggests that the presence of of appropriate patients with inoperable NSCLC for platinum-based a systemic inflammatory response may be an important factor in chemotherapy. REFERENCES Ando M, Ando Y, Hasegawa Y, Shimokata K, Minami H, Wakai K, Ohno Y, Mountain CF (1991) A new international staging system for lung cancer. Sakai S (2001) Prognostic value of performance status assessed by Chest 89(Suppl 4): 225s–233s patients themselves, nurses, and oncologists in advanced non-small cell Numico G, Russi E, Merlano M (2001) Best supportive care in non-small lung cancer. Br J Cancer 85: 1634–1639 cell lung cancer: is there a role for radiotherapy and chemotherapy? Lung Bennett M, Ryall N (2000) Using the modified Barthel index to estimate Cancer 32: 213– 226 survival in cancer patients in hospice: observational study. BMJ O’Gorman P, McMillan DC, McArdle CS (2000) Prognostic factors in 321(7273): 1381–1382 advanced gastrointestinal cancer patients with weight loss. Nutr Cancer Chlebowski RT, Palomares MR, Lillington L, Grosvenor M (1996) Recent 37: 36–40 implications of weight loss in lung cancer management. Nutrition 12(1 Paesmans M, Sculier JP, Libert P, Bureau G, Dabouis G, Thiriaux J, Michel Suppl): S43–7 J, Van Cutsem O, Sergysels R, Mommen P, Klastersky J (1997) Response Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ (2003) to chemotherapy has predictive value for further survival of patients with Evaluation of cumulative prognostic scores based on the systemic advanced non-small cell lung cancer: 10 years experience of the inflammatory response in patients with inoperable non-small-cell lung European Lung Cancer Working Party. Eur J Cancer 33: 2326–2332 cancer. Br J Cancer 89: 1028–1030 Rivory LP, Slaviero KA, Clarke SJ (2002) Hepatic cytochrome P450 3A drug Ikeda M, Natsugoe S, Ueno S, Baba M, Aikou T (2003) Significant host- and metabolism is reduced in cancer patients who have an acute-phase tumor-related factors for predicting prognosis in patients with response. Br J Cancer 87: 277–280 esophageal carcinoma. Ann Surg 238: 197– 202 Scott HR, McMillan DC, Forrest LM, Brown DJF, McArdle CS, Milroy R Klastersky J, Paesmans M (2001) Response to chemotherapy, quality of life (2002) The systemic inflammatory response, weight loss, performance benefits and survival in advanced non-small cell lung cancer: review of status and survival in patients with inoperable non-small cell lung literature results. Lung Cancer 34(Suppl 4): S95–S101 cancer. Br J Cancer 87: 264–267 Mahmoud FA, Rivera NI (2002) The role of C-reactive protein as a Slaviero KA, Clarke SJ, Rivory LP (2003) Inflammatory response: prognostic indicator in advanced cancer. Curr Oncol Rep 4: 250–255 an unrecognised source of variability in the pharmacokinetics McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory and pharmacodynamics of cancer chemotherapy. Lancet Oncol 4: response predicts survival following curative resection of colorectal 224–232 cancer. Br J Surg 90: 215–219 Sloan JA, Loprinzi CL, Laurine JA, Novotny PJ, Vargas-Chanes D, Krook JE, McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS O’Connell MJ, Kugler JW, Tirona MT, Kardinal CG, Wiesenfeld M, (2001) Albumin concentrations are primarily determined by the body Tschetter LK, Hatfield AK, Schaefer PL (2001) A simple stratification cell mass and the systemic inflammatory response in cancer patients with factor prognostic for survival in advanced cancer: the good/bad/ weight loss. Nutr Cancer 39: 210–213 uncertain index. J Clin Oncol 19: 3539–3546 British Journal of Cancer (2004) 90(9), 1704 – 1706 & 2004 Cancer Research UK

Journal

British Journal of Cancer – Springer Journals

Published: Apr 13, 2004

There are no references for this article.