Introduction Oesophageal and gastric cancer resections carry a high risk of morbidity and mortality.1It is important that patients undergoing such surgery survive long enough to reap the benefits of resection. Pre-operative CRP and Albumin levels are simple markers that can be combined to form a Glasgow prognostic score (GPS), which has demonstrable prognostic value in colorectal cancers.2,3 The aim of this is study is to assess whether GPS can predict patient survival following oesophageal and gastric resections for malignant disease.
Method NHS Highland holds a prospective database of all patients undergoing oesophageal and gastric resections for malignant disease. This database was reviewed for patients operated on between January 2005–June 2014. Data on pre-operative CRP and Albumin levels were collected retrospectively from the trust–s SCISTORE®results system, to calculate a GPS score:
GPS-0: CRP <10 mg/L
GPS-1: CRP > 10 mg/L, Albumin > 35 g/L
GPS-2: CRP > 10 mg/L; Albumin < 35 g/L
TNM staging of the pathology specimen was also recorded to derive a pathology score:
TxNyMx: Pathology score = x + y + z
Data on GPS, survival and pathology scores were analysed in SPSS®version 21 using one-way ANOVA tests.
Results The database contained 179 patients. Of these 110 (61.5%) had both pre-operative CRP and Albumin levels documented to derive a GPS score. 61 patients had a GPS score of 0, 34 a score of 1 and 15 a score of 2. The median survival post-resection was 31, 24.5 and 6 months respectively. One-way ANOVA demonstrated a significant difference in survival between groups (p-value of 0.049). GPS scores were also compared to pathology scores. The mean pathology score was 2.88, 3.04 and 4.11 for the respective GPS groups of 0–2, with ANOVA tests again demonstrating a significant difference (p-value of 0.017).
Conclusion GPS is a useful marker for patients about to embark of oesophageal and gastric resectional surgery for malignant disease. Patients with a GPS score of 2 appear to be poor surgical candidates, with more advanced tumours and survivals too short to derive benefit from surgical resection. The use of GPS scoring could be a helpful tool in MDT decision making.
Disclosure of interest None Declared.
D. Amico T. Outcomes after surgery for oesophageal cancer. Gastrointest. Cancer Res. 2007 September-October;1(5):188-196
McMillan DC, Crozier JE, Canna K, et al. Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007;22:881–6
Nakagawa K, Tanaka K, Kazunori N, et al. The modified glasgow prognostic score as a predictor of survival after hepatectomy for colorectal liver metastases. Ann Surg Oncol. 2014;21:1711–1718