Inflammation-based prognostic score, prior to neoadjuvant chemoradiotherapy, predicts postoperative outcome in patients with esophageal squamous cell carcinoma

Background. Recent studies have revealed that Glasgow prognostic score (GPS), an inflammation-based prognostic score, is associated. with poor outcome in a variety of tumors. However, few studies have investigated whether GPS measured prior to neoadjuvant chemoradiotherapy (nCRT) is useful for postoperative prognosis of patients with advanced esophageal squamous cell carcinoma (ESCC). Methods. GPS was calculated on the basis of admission data as follows: patients with both an elevated C-reactive protein (>10 mg/L) and hypoalbuminaemia (<35 g/L) were allocated a GPS score of 2. Patients in whom only 1 of these biochemical abnormalities was present were allocated a GPS score of 1, and patients with a normal C-reactive protein and albumin were allocated a score of 0. All patients underwent radical en-bloc resection 3-4 weeks after nCRT. Results. A total of 48 patients with clinical TNM stage II/III were enrolled. Univariate analyses revealed that there were significant differences in cancer-specific survival in relation to grade of response to nCRT(P=.004), lymph node status (P=.0065), lymphatic invasion (P=.0002), venous invasion (P=.0001), pathological TNM classification (P=.015), and GPS (P<.0001). GPS classification showed it close relationship with lymphatic invasion, venous invasion, and number of lymph node (P=.0292, .0473, and .0485, respectively). GPS was found to be the only independent predictor of cancer-specific survival (odds ratio, 0.17; 95% confidence interval, 0.06-0.52; P=.0019). Conclusions. GPS, measured prior to nCRT, is an independent novel predictor of postoperative outcome in patients with advanced ESCC. (Surgery 2008;144:729-35.)