Applicability of modified Glasgow Prognostic Score in the assessment of elderly patients with cancer: A pilot study

Abstract

Objectives

To evaluate the relationship between inflammatory parameters through the modified Glasgow Prognostic Score (mGPS) and other clinical characteristics of elderly patients with cancer, including frailty evaluated by the Edmonton Frailty Scale (EFS).

Materials and Methods

We included patients from the oncology service at Faculdade de Medicina do ABC with a confirmed diagnosis of solid tumor aged 65 years or more at diagnosis. Patients were assessed by applying the translated and validated to Portuguese version of the EFS and also had blood sample collection for the evaluation of C-reactive protein (CRP) and albumin for calculation of the mGPS.

Results

We included 52 patients of both sexes, with median age of 72.5 years, of these 67.3% had localized disease and 32.7% metastatic disease. The mGPS presented 17.3% of high-risk patients. The frailty evaluated by EFS occurred in 57.6% of patients. Patients with both abnormal parameters (CRP and albumin) in the mGPS had significantly higher scores on EFS when compared to those with no change (6 vs. 9.56 points, p = 0.021). The mGPS correlated also with clinical staging (p = 0.019) and performance status (p = 0.039).

Conclusions

Inflammatory parameters correlate significantly with frailty, more advanced clinical stage and poor functional status.

Introduction

About 60% of new cases of cancer and 70% of mortality related to this disease occur in patients over 65 years of age [1], [2], [3]. Therefore, the oncologist should determine the best treatment for this clinically heterogeneous age group, ranging from those with multiple comorbidities that limit their quality of life and functional status to those with good health. Furthermore, elderly patients included in clinical studies often represent a carefully selected subset that usually does not include frail elderly and more debilitated subjects.

Frailty is defined as the loss of the ability to adapt to stress due to reduced functional reserves. Frail individuals have a higher risk of complications such as hospitalizations, falls, functional decline, difficulties in recovering from acute insults, greater risk of adverse events and mortality [4], [5]. There are several methods in the literature designed to evaluate for the presence of frailty in the elderly [6], [7]. Among them, the Edmonton Frail Scale (EFS) [7], already translated and validated into Portuguese [6], allows for the detection of frailty in the elderly population in an easy and expedient way.

Frailty is a multifactorial syndrome which has neuroendocrine and inflammatory components in its pathophysiology. Many authors proposed potential biological markers for this syndrome, but no typical laboratory profile associated with frailty has so far emerged. Interestingly, however, increased values of interleukin-6 (IL-6) and C-reactive protein (CRP) correlate with low body mass index (BMI) and frailty [8], [9]. Additionally, there is evidence that the host's inflammatory response plays a significant role in the development and progression of cancer [10], [11], [12], [13], [14].

The assessment of systemic inflammatory response was refined using a selective combination of CRP and albumin called the modified Glasgow Prognostic Score (mGPS) [15], [16], [17], [18]. Recently, it has been shown in a large study group with more than 200,000 patients (Glasgow Outcome Inflammation Study), that the mGPS is elevated in patients with cancer, when compared with those without cancer [17]. Furthermore, mGPS is an independent prognostic factor for several types of cancer including lung, gastrointestinal, and renal neoplasms [17].

Since mGPS is easy to measure and relates to inflammation, which is one of the mechanisms underlying frailty, the objective of this study was to evaluate whether mGPS is associated with frailty and other clinical characteristics of elderly patients with cancer at initial presentation.