Predictive value of Glasgow prognostic score in patients with colorectal cancer undergoing laparoscopic radical resection / 中华胃肠外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the predictive value of preoperative Glasgow prognostic score (GPS) for the postoperative complications and survival in patients with colorectal cancer (CRC) undergoing laparoscopic radical resection.</p><p><b>METHODS</b>This retrospective study was conducted in the Beijing Hospital between January 2009 and January 2012. A total of 228 patients with primary CRC undergoing laparoscopic radical resection were analyzed. The GPS was constructed based on routine preoperative blood tests of C-reactive protein and serum albumin. The patients were classified into three groups according to GPS (GPS 0, 1, 2 groups). Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the influence of GPS on prognosis in patients with CRC undergoing laparoscopic radical resection.</p><p><b>RESULTS</b>Preoperative CRP level was increased in 48 cases (21.1%), and preoperative serum albumin level was decreased in 104 cases (45.6%) in the whole group. These 228 patients were classified into 99, 105 and 24 patients in GPS 0, 1, 2 group respectively. GPS was significantly associated with age, preoperative body mass index (BMI), carcinoembryonic antigen (CEA), CA19-9, tumor location, tumor differentiation and TNM stage (all P<0.05). Postoperative complication rates of GPS 0, 1, 2 group were 6.1%, 14.3% and 70.8% respectively (χ=59.147, P=0.000). Serious postoperative complication rates were 3.0%, 6.7% and 58.3% respectively (χ=65.807, P=0.000). Univariate and multivariate analyses revealed that GPS was an independent risk factor of postoperative complications(HR=21.611, 95%CI 5.936-78.681, P=0.000) and severe complications (HR=35.833, 95%CI 7.364-174.355, P = 0.000). The 5-year survival rate was 50% and the average total survival time was 58.2 (95% CI 54.6-61.7) months in the whole group. The median overall survival time in GPS 0, 1, 2 group was 74.6(95%CI 70.4-78.7) months, 49.8(95%CI 45.2-54.4) months and 27.8 (95%CI 21.8-33.8) months respectively(χ=98.425, P=0.000). The median disease-free survival time was 73.9(95%CI 69.2-78.7) months, 47.4 (95% CI 41.6-53.1) months and 19.9 (95%CI 14.8-25.0) months respectively (χ=91.305, P=0.000). GPS was an independent risk factor of disease-free survival (HR=4.840, 95%CI 2.413-9.709, P=0.000) and overall survival (HR=6.267, 95%CI 3.073-12.784, P=0.000).</p><p><b>CONCLUSIONS</b>GPS can be used as an effective predictor of the prognosis for patients with CRC undergoing laparoscopic radical surgery. Higher GPS suggests more postoperative complications and worse prognosis.</p>