Systemic Inflammation, Survival of Prostate Cancer Patients
Systemic Inflammation, Survival of Prostate Cancer Patients
From the Glasgow Inflammation Outcome Study of 223 303 patients originally described, 27 301 patients were identified as having a diagnosis of cancer by Scottish Cancer Registry and a blood sample for C-reactive protein, albumin, white cells, neutrophil, lymphocyte and platelet counts taken between January 2000 and December 2007. From this cohort, 897 patients who had a diagnosis of prostate cancer and had been sampled within 2 years before or after diagnosis, were included in this study. The majority, 575 (64%), were aged 75 or over. In all, 19% of patients lived in affluent areas (least deprived quintile of the Scottish population) and 34% in deprived areas (most deprived quintile of the Scottish population). The median follow-up from the cancer diagnosis was 2.5 years, and maximum 6.2 years.
Patients with an elevated mGPS (mGPS 1 and 2) were more likely to be 75 years or older (P=0.005) and have high-grade disease (Gleason 8–10) (P<0.001), but there was no association with socioeconomic circumstances based on SIMD (P=0.430). Similarly, patients with an elevated NLR (NLR score 1) were more likely to be older (P=0.022) and have a raised mGPS (P<0.001) but there was no significant association with socio-economic circumstances (P=0.338) or Gleason grade (P=0.074).
The individuals who had missing NLR were significantly older (2.3 years, P value <0.002, t=2.95) than those whose NLR data were available, whereas no significant differences were observed in distribution of Gleason grade (X, P=0.08) and socioeconomic circumstances (X, P=0.617). Furthermore, mean survival time was ~6 months higher for those whose NLR was missing compared with those whose NLR was available.
Baseline characteristics of prostate cancer patients, before and after sampling, are shown in Table 2. Patients who were sampled in the post-diagnosis group, compared with the pre-diagnosis group, were more likely to be older (P<0.001), have higher Gleason grade (P<0.001), come from less deprived areas (P<0.05), and have higher mGPS (P<0.01) and NLR (P<0.001) values. Patients who died in the post-diagnosis group, compared with the pre-diagnosis group, were more likely to be younger (P<0.001), have higher Gleason grade (P<0.001), and higher mGPS (P<0.05) and NLR (P<0.001) values. Because of differences in pre- and post-diagnosis sample characteristics, we conducted survival analyses for each separately.
Increasing age and high or unknown Gleason grade were associated with poorer 5-year relative survival (Table 3 and Table 4). The 5-year relative survival of prostate cancer patients sampled before diagnosis was modelled using the full likelihood approach and is shown in Table 3. On univariate analysis, patients older than 75 years of age (P<0.05), with high or unknown Gleason grade (P<0.01), raised mGPS (P<0.001) and a raised NLR (P<0.01) were significantly more likely to die. On multivariate analysis, high (RER 5.15, 95% confidence interval (CI) 1.74–15.20) and unknown (RER 27.54, 95% CI 9.07–83.64) Gleason grade and mGPS of 2 (RER 2.08, 95% CI 1.13–3.81) were the major predictors of RER of death after adjusting for age, Gleason grade, socioeconomic circumstances and NLR (Table 3).
Five year relative survival of prostate cancer patients sampled after diagnosis modelled using the full likelihood approach is shown in Table 4. On univariate analysis, patients older than 75 years of age (P<0.05), with high or unknown Gleason grade (P<0.001), raised mGPS (P<0.001) and raised NLR (P<0.001) were significantly more likely to die. On multivariate analysis, increasing or unknown Gleason grade, mGPS of 2 (RER=2.93, 95% CI 1.81–4.78) and NLR ≥5:1 (RER 2.38, 95% CI 2.38) were significant predictors of death after adjusting for other factors (Table 4). There was no significant interaction between the NLR and mGPS while employing these excess risk models.
When this analysis was repeated based on their Gleason grade we observed a significant association between raised mGPS and risk of death with the low-grade group (RER 7.58, 95% CI 1.44–39.76), higher Gleason grade category (RER 2.08, 95% CI 1.26–3.45) and those with unknown Gleason grades (RER 1.97, 95% CI 1.03–3.73) after adjustment for age, socioeconomic circumstances and NLR (Table 5). In grade-specific analysis, NLR only showed a significant association with risk of death for unknown Gleason grade after adjustments for age, socioeconomic circumstances and mGPS (Table 5). Similarly, age-specific analyses were also carried out and raised mGPS showed significantly higher risk of death among those with age <65 and 65–74 years at diagnosis. However, a nonsignificant increased risk of death was also observed among those aged >75 years (data not shown).
Figure 1 shows the relative survival of high-grade (Gleason 8–10) prostate cancer patients based on the mGPS. Analysis of this subgroup showed that the mGPS was associated with reduced survival with a mGPS of 2 having 29% lower 3-year relative survival, when compared with those with an mGPS of 0.
(Enlarge Image)
Figure 1.
Three years relative survival of high-grade (Gleason 8–10) prostate cancer patients based on modified Glasgow Prognostic Score (mGPS).
Results
From the Glasgow Inflammation Outcome Study of 223 303 patients originally described, 27 301 patients were identified as having a diagnosis of cancer by Scottish Cancer Registry and a blood sample for C-reactive protein, albumin, white cells, neutrophil, lymphocyte and platelet counts taken between January 2000 and December 2007. From this cohort, 897 patients who had a diagnosis of prostate cancer and had been sampled within 2 years before or after diagnosis, were included in this study. The majority, 575 (64%), were aged 75 or over. In all, 19% of patients lived in affluent areas (least deprived quintile of the Scottish population) and 34% in deprived areas (most deprived quintile of the Scottish population). The median follow-up from the cancer diagnosis was 2.5 years, and maximum 6.2 years.
Patients with an elevated mGPS (mGPS 1 and 2) were more likely to be 75 years or older (P=0.005) and have high-grade disease (Gleason 8–10) (P<0.001), but there was no association with socioeconomic circumstances based on SIMD (P=0.430). Similarly, patients with an elevated NLR (NLR score 1) were more likely to be older (P=0.022) and have a raised mGPS (P<0.001) but there was no significant association with socio-economic circumstances (P=0.338) or Gleason grade (P=0.074).
The individuals who had missing NLR were significantly older (2.3 years, P value <0.002, t=2.95) than those whose NLR data were available, whereas no significant differences were observed in distribution of Gleason grade (X, P=0.08) and socioeconomic circumstances (X, P=0.617). Furthermore, mean survival time was ~6 months higher for those whose NLR was missing compared with those whose NLR was available.
Baseline characteristics of prostate cancer patients, before and after sampling, are shown in Table 2. Patients who were sampled in the post-diagnosis group, compared with the pre-diagnosis group, were more likely to be older (P<0.001), have higher Gleason grade (P<0.001), come from less deprived areas (P<0.05), and have higher mGPS (P<0.01) and NLR (P<0.001) values. Patients who died in the post-diagnosis group, compared with the pre-diagnosis group, were more likely to be younger (P<0.001), have higher Gleason grade (P<0.001), and higher mGPS (P<0.05) and NLR (P<0.001) values. Because of differences in pre- and post-diagnosis sample characteristics, we conducted survival analyses for each separately.
Increasing age and high or unknown Gleason grade were associated with poorer 5-year relative survival (Table 3 and Table 4). The 5-year relative survival of prostate cancer patients sampled before diagnosis was modelled using the full likelihood approach and is shown in Table 3. On univariate analysis, patients older than 75 years of age (P<0.05), with high or unknown Gleason grade (P<0.01), raised mGPS (P<0.001) and a raised NLR (P<0.01) were significantly more likely to die. On multivariate analysis, high (RER 5.15, 95% confidence interval (CI) 1.74–15.20) and unknown (RER 27.54, 95% CI 9.07–83.64) Gleason grade and mGPS of 2 (RER 2.08, 95% CI 1.13–3.81) were the major predictors of RER of death after adjusting for age, Gleason grade, socioeconomic circumstances and NLR (Table 3).
Five year relative survival of prostate cancer patients sampled after diagnosis modelled using the full likelihood approach is shown in Table 4. On univariate analysis, patients older than 75 years of age (P<0.05), with high or unknown Gleason grade (P<0.001), raised mGPS (P<0.001) and raised NLR (P<0.001) were significantly more likely to die. On multivariate analysis, increasing or unknown Gleason grade, mGPS of 2 (RER=2.93, 95% CI 1.81–4.78) and NLR ≥5:1 (RER 2.38, 95% CI 2.38) were significant predictors of death after adjusting for other factors (Table 4). There was no significant interaction between the NLR and mGPS while employing these excess risk models.
When this analysis was repeated based on their Gleason grade we observed a significant association between raised mGPS and risk of death with the low-grade group (RER 7.58, 95% CI 1.44–39.76), higher Gleason grade category (RER 2.08, 95% CI 1.26–3.45) and those with unknown Gleason grades (RER 1.97, 95% CI 1.03–3.73) after adjustment for age, socioeconomic circumstances and NLR (Table 5). In grade-specific analysis, NLR only showed a significant association with risk of death for unknown Gleason grade after adjustments for age, socioeconomic circumstances and mGPS (Table 5). Similarly, age-specific analyses were also carried out and raised mGPS showed significantly higher risk of death among those with age <65 and 65–74 years at diagnosis. However, a nonsignificant increased risk of death was also observed among those aged >75 years (data not shown).
Figure 1 shows the relative survival of high-grade (Gleason 8–10) prostate cancer patients based on the mGPS. Analysis of this subgroup showed that the mGPS was associated with reduced survival with a mGPS of 2 having 29% lower 3-year relative survival, when compared with those with an mGPS of 0.
(Enlarge Image)
Figure 1.
Three years relative survival of high-grade (Gleason 8–10) prostate cancer patients based on modified Glasgow Prognostic Score (mGPS).
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