Glasgow Prognostic Score As a Prognostic Factor in Metastatic Castration-Resistant Prostate Cancer Treated With Docetaxel-Based Chemotherapy

The modified Glasgow Prognostic Score (mGPS) and neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic significance in several malignancies. Both were calculated in a prospective cohort of 220 chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC) who received docetaxel and prednisone +/- AT101. An association between mGPS and overall survival (OS) was found (hazard ratio [HR], 1.87; P < .001), whereas NLR was not prognostic (HR, 0.98; P = .91). mGPS determination is inexpensive and easily measured. It requires validation in another cohort to determine if it should be incorporated into routine testing. Background: The modified Glasgow Prognostic Score (mGPS), derived from C-reactive protein (CRP) and albumin levels, and the neutrophil-lymphocyte ratio (NLR) have demonstrated prognostic significance in a number of malignancies. Patients and Methods: Baseline mGPS and NLR were calculated in a prospective cohort of chemotherapy-naive patients with metastatic castration-resistant prostate cancer (mCRPC) (AT-101-CS-205 trial) who received docetaxel and prednisone +/- AT101. Cox proportional hazards regression models estimated their effects on overall survival (OS). Results: Of 220 eligible patients, mGPS and neutrophil and lymphocyte counts were available for 184, 193, and 112 patients, respectively. Albumin (hazard ratio [HR], 0.28; 95% confidence interval [CI]: 0.14-0.56; P < .001) and CRP (HR, 1.22; 95% CI, 1.00-1.48; P = .048) were independently prognostic for OS. An association between mGPS and OS was found (HR, 1.87; 95% CI, 1.35-2.59; P < .001; median survival, 23.5 months at mGPS 0 vs. 9.8 months at mGPS 2). mGPS was significant after controlling for 3 previously published nomograms or NLR (P <= .001). NLR was not prognostic for OS (HR, 0.98; P = .91), and no association between mGPS and toxicity was noted. Conclusion: Our results demonstrate the prognostic role of the mGPS in mCRPC over variables previously identified. mGPS is inexpensive, easily measured, and could be incorporated into routine clinical testing if our results are confirmed in a subsequent validation study. The utility of the NLR in mCRPC remains uncertain despite evidence in other malignancies.