Does the Modified Glasgow Prognostic Score Aid in the Management of Patients Undergoing Surgery for a Soft Tissue Sarcoma?

Spence S, Gupta S, Alanie O, Ong J, Findlay H and Mahendra A

Department of Trauma and Orthopaedics, Glasgow, Scotland

^*Correspondance to: Stephanie Spence 

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Abstract:

Background: The prognosis of sarcoma patients is associated with symptom duration, patient age as well as tumour grade, size and depth. The modified Glasgow Prognostic Score (mGPS) is a validated prognostic indicator in various carcinomas, including renal, gastric, colorectal and hepatocellular carcinomas as demonstrated by several meta-analyses. The mGPS takes into account a patient’s preoperative CRP and albumin values to calculate a score from 0 to 2 that correlates with their overall outcome. A score of 2 is associated with a poorer outcome in certain cancers. To date there is little evidence supporting this correlation in the sarcoma patient group.
Purpose: We therefore asked if the markers of systemic inflammatory response (mGPS) are reliable as a prognostic indicator for patients with a diagnosis of a Soft Tissue Sarcoma (STS) and would incorporating these markers into every day practice for future STS patients be beneficial.
Methods: All patients with a STS diagnosis presenting to our regional unit during the calendar years 2010-2014 were included. These patients were identified using our prospectively collected MSK oncology database. We performed a retrospective electronic case note review examining patient demographics, preoperative blood results including CRP and albumin and oncological outcomes. Patient outcomes were grouped as follows: no recurrence, local recurrence, metastatic disease and death. The data was analyzed using uni- and multivariate analysis.
Results: There were 85 patients who met the inclusion criteria. Of these 56% were female and 55% were aged over 50 years. 94% of tumours were high grade (Trojani 2/3) and 74% were >5 cm. 48 patients had an mGPS score of 0, 15 had an mGPS of 1 and 22 had an mGPS of 2. On univariate analysis, mGPS was the only statically significant result with regards to the cancer specific survival, p=0.02. With regards to overall survival the mGPS and size of the tumour were both statistically significant p ≤ 0.001 and P=0.016 respectively. In addition, on univariate analysis, we also found a statistically significant association between CRP, albumin, tumour size and neutrophil count to the development of metastasis and death.
Conclusion: This study has shown that pre-treatment CRP and albumin level (mGPS) are important factors in predicting oncological outcome. The numbers of cases of local recurrence were too few for any association to be identified. A score of 0 relates to an improved prognosis whilst a score of 2 relates to an increased risk of developing metastatic disease and death. mGPS as a prognostic indicator was not affected by either the tumour size or grade. The group of patients with an mGPS score of 1 was not large enough for any statistically significant conclusions to be drawn. Although we did not find histological tumour grade to directly relate to the oncological outcome, this has been previously demonstrated. We believe that a pre-operative mGPS should be calculated to help predict oncological outcome and in turn influence management. Further work is being undertaken with a larger cohort.

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Cite the Article:

Spence S, Gupta S, Alanie O, Ong J, Findlay H, Mahendra A. Does the Modified Glasgow Prognostic Score Aid in the Management of Patients Undergoing Surgery for a Soft Tissue Sarcoma?. World J Surg Surgical Res. 2019; 2: 1097.