PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：基于炎症的改良格拉斯哥预后评分（mGPS）结合了C反应蛋白和白蛋白的血清水平，并被证明可以预测晚期癌症的生存率。我们旨在阐明在随机III期XELAVIRI试验中接受一线化疗的未经选择的转移性结直肠癌（mCRC）患者中，mGPS对生存的预后影响及其与性别相结合的预测价值。
方法：在XELAVIRI中，mCRC患者接受氟嘧啶/贝伐单抗治疗,随后在首次进展时(序贯治疗组;A组)或接受氟嘧啶/贝伐单抗/伊立替康的前期组合治疗(强化治疗组;B组).在目前的事后分析中，根据mGPS分类0,1或2对生存率进行评估.分析了mGPS与性别之间的相互作用。
结果：在接受XELAVIRI治疗的421例mCRC患者中，362[119名女性（32.9%）和243名男性（67.1%）]可评估。对于整个研究人群，观察到mGPS与总生存期（OS）之间存在显着关联[mGPS=0：中位数28.9个月，95%置信区间（CI）25.9-33.6个月；mGPS=1：中位数21.4个月，95%CI17.6-26.1个月；mGPS=2：中位数16.8个月，95%CI14.3-21.2个月；P<0.00001]。当比较组间无进展生存期时发现类似的结果。mGPS对生存的影响不依赖于所应用的治疗方案(P=0.21)。在女性患者中，在A臂与B臂中观察到OS更长的趋势，这种影响在mGPS队列0中明显更明显（41.6对25.5个月；P=0.056）。相比之下,与A组相比,B组治疗的mGPS为1-2的男性患者的中位OS更长(20.8个月对17.4个月;P=0.022).
结论：我们证明了在接受一线治疗的mCRC患者中，无论治疗方案如何，mGPS作为OS的独立预测因子的作用。mGPS可能有助于识别或多或少受益于前期强化治疗的性别特异性亚组。
方法：在XELAVIRI中，mCRC患者接受氟嘧啶/贝伐单抗治疗,随后在首次进展时(序贯治疗组;A组)或接受氟嘧啶/贝伐单抗/伊立替康的前期组合治疗(强化治疗组;B组).在目前的事后分析中，根据mGPS分类0,1或2对生存率进行评估.分析了mGPS与性别之间的相互作用。
结果：在接受XELAVIRI治疗的421例mCRC患者中，362[119名女性（32.9%）和243名男性（67.1%）]可评估。对于整个研究人群，观察到mGPS与总生存期（OS）之间存在显着关联[mGPS=0：中位数28.9个月，95%置信区间（CI）25.9-33.6个月；mGPS=1：中位数21.4个月，95%CI17.6-26.1个月；mGPS=2：中位数16.8个月，95%CI14.3-21.2个月；P<0.00001]。当比较组间无进展生存期时发现类似的结果。mGPS对生存的影响不依赖于所应用的治疗方案(P=0.21)。在女性患者中，在A臂与B臂中观察到OS更长的趋势，这种影响在mGPS队列0中明显更明显（41.6对25.5个月；P=0.056）。相比之下,与A组相比,B组治疗的mGPS为1-2的男性患者的中位OS更长(20.8个月对17.4个月;P=0.022).
结论：我们证明了在接受一线治疗的mCRC患者中，无论治疗方案如何，mGPS作为OS的独立预测因子的作用。mGPS可能有助于识别或多或少受益于前期强化治疗的性别特异性亚组。
