• J Pain Symptom Manage · Apr 2023

    Inflammation and performance status: the cornerstones of prognosis in advanced cancer.

    • Bruna M M Rocha, Ross D Dolan, Carlos E Paiva, Josh McGovern, Bianca S R Paiva, Daniel D Preto, Donald C McMillan, Yara C P Maia, and Barry J Laird.
    • Nutrition and Molecular Biology Research Group (B.M.M.R., Y.C.P.M.), School of Medicine, Federal University of Uberlandia, Minas Gerais, Uberlandia, Brazil.
    • J Pain Symptom Manage. 2023 Apr 1; 65 (4): 348357348-357.

    ContextIn advanced cancer, although performance status (PS), systemic inflammatory response and nutritional status are known to have prognostic value, geographical variations and sociodemographic indexes may also impact survival.ObjectivesThis study compares validated prognostic factors in two international cohorts and establishes a prognostic framework for treatment.MethodsTwo international biobanks of patients (n=1.518) with advanced cancer were analyzed. Prognostic factors (Eastern Cooperative Oncology Group Performance Status [ECOG-PS], body mass index [BMI] and modified Glasgow Prognostic Score [mGPS]) were assessed. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods.ResultsAccording to multivariate analysis, in the European cohort the most highly predictive factors were BMI <20 kg/m2 (hazard ratio [HR] 1.644), BMI 20-21.9 kg/m2 (HR 1.347), ECOG-PS (HR 1.597-11.992) and mGPS (HR 1.843-2.365). In the Brazilian cohort, the most highly predictive factors were ECOG-PS (HR 1.678-8.938) and mGPS (HR 2.103-2.837). Considering gastrointestinal cancers in particular (n=551), the survival rate at 3 months in both cohorts together ranged from 93% (mGPS 0, PS 0-1) to 0% (mGPS 2, PS 4), and from 81% (mGPS 0, BMI >28 kg/m2) to 44% (mGPS 2, BMI <20 kg/m2).ConclusionThe established prognostic factors that were compared had similar prognostic capacity in both cohorts. A high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer survival of patients with advanced cancer in the prospective European and Brazilian cohorts.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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