Donald C. McMillan. The systemic inflammation-based Glasgow Prognostic Score: A decade of experience in patients with cancer. Cancer Treatment Reviews, http://dx.doi.org/10.1016/j.ctrv.2012.08.003
GPSはCRP1mg/dlとアルブミン3.5mg/dlをカットオフの数値として、0-2点と採点する簡単なスコアリング方式です。modifiedGPSではCRP陰性でアルブミン3.5mg/dlのことは稀のため、この項目がなくなっています。
結果ですが、がん患者でGPS/mGPSの得点が高いほど、体重減少、筋肉量減少、機能低下、併存疾患増加、炎症性サイトカイン高値、治療の合併症を認めました。GPS/mGPSによる慢性炎症の存在は、がん患者の予後と明らかに関連していました。
GPS/mGPSは悪液質の指標の1つと考えます。抄録の最後にもありますが、がん以外の疾患でもGPS/mGPSが予後指標として使用できるかどうかが興味深いです。おそらく悪液質・慢性炎症性疾患に関しては当てはまると思いますが、カットオフ値が同じでよいのかどうかはわかりません。
| The Glasgow Prognostic Score (GPS) | Points allocated |
|---|---|
| C-Reactive protein ⩾10 mg/l and albumin ⩾35 g/l | 0 |
| C-Reactive protein 10mg/l以上 | 1 |
| Albumin 35g/dl以下 | 1 |
| C-Reactive protein 10mg/l以上かつAlbumin 35g/dl以下 | 2 |
| The modified Glasgow Prognostic Score (mGPS) | |
| C-Reactive protein ⩽ 10 mg/l and albumin ⩾35 g/l | 0 |
| C-Reactive protein 10mg/l以上 | 1 |
| C-Reactive protein 10mg/l以上かつAlbumin 35g/dl以下 | 2 |
Summary
Since the initial work, a decade ago that the combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with cancer, there have been more than 60 studies (>30,000 patients) that have examined and validated the use of the GPS or the modified GPS (mGPS) in a variety of cancer scenarios. The present review provides a concise overview of these studies and comments on the current and future clinical utility of this simple objective systemic inflammation-based score. The GPS/mGPS had independent prognostic value in (a) unselected cohorts (4 studies, >19,400 patients) (b) operable disease (28 studies, >8,000 patients) (c) chemo/radiotherapy (11 studies, >1500 patients) (d) inoperable disease (11 studies, >2,000 patients). Association studies (15 studies, >2,000 patients) pointed to an increased GPS/mGPS being associated with increased weight and muscle loss, poor performance status, increased comorbidity, increased pro-inflammatory and angiogenic cytokines and complications on treatment. These studies have originated from 13 different countries, in particular the UK and Japan. A chronic systemic inflammatory response, as evidenced by the GPS/mGPS, is clearly implicated in the prognosis of patients with cancer in a variety of clinical scenarios. The GPS/mGPS is the most extensively validated of the systemic inflammation-based prognostic scores and therefore may be used in the routine clinical assessment of patients with cancer. It not only identifies patients at risk but also provides a well defined therapeutic target for future clinical trials. It remains to be determined whether the GPS has prognostic value in other disease states.
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