Utility of inflammation-based prognostic scoring in patients given systemic chemotherapy first-line for advanced inoperable bladder cancer.

OBJECTIVE: Our intent was to investigate the impact of specific parameters-clinical status, performance status (Eastern Cooperative Oncology Group (ECOG)), C-reactive protein, serum albumin, and inflammation (Glasgow Prognostic Score)-on progression-free survival and overall survival in patients given systemic chemotherapy as the first-line treatment of advanced bladder cancer.

METHODS: A total of 67 patients treated for advanced bladder cancer in a 7-year period (2004-10) were reviewed. Prior to administration of first-line chemotherapy (gemcitabine plus cisplatin), baseline ECOG performance status, C-reactive protein, albumin, Glasgow Prognostic Score and clinical status were assessed. Patients with both elevated C-reactive protein (>1.0 mg/dl) and low albumin (<3.5 mg/dl) were assigned a Glasgow Prognostic Score of 2, while lesser scores were set when one (Glasgow Prognostic Score 1) or both levels (Glasgow Prognostic Score 0) were within the normal range. To evaluate relationships to progression-free survival and overall survival, univariate and multivariate analyses were conducted.

RESULTS: By multivariate analysis,  ECOG performance status (hazard ratio = 3.48, 95% confidence interval 1.87-6.45, P = 0.001) and hypoalbuminemia (hazard ratio = 2.04, 95% confidence interval 1.10-3.78, P = 0.023) were found to be factors independently associated with reduced progression-free survival. Factors independently associated with shortened overall survival were ECOG performance status (hazard ratio = 5.32, 95% confidence interval 2.22-12.71, P = 0.001) and Glasgow Prognostic Score 2 (hazard ratio = 7.00, 95% confidence interval 2.53-19.36, P = 0.001).

CONCLUSIONS: These outcomes indicate that a systemic inflammatory response coupled with hypoalbuminemia (Glasgow Prognostic Score 2) correlates significantly with shortened overall survival and may thus be useful as a prognostic index in this setting.