Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 6, December 2017, pages 359-365

Is the Glasgow Prognostic Score Applicable to Both Early- and Advanced-Stage Gastric Cancers?

Figure 1. Relationship between the GPS and overall survival among patients with early-stage (pStage I) gastric cancer. The 3- and 5-year overall survival rates among patients with GPS of 0 were 97.1% and 95.1%, respectively; the corresponding rates among patients with GPSs of 1 - 2 were 88.1% and 80.7%, respectively. GPS: Glasgow prognostic score.

Figure 2. Relationship between the GPS and overall survival among patients with advanced-stage (pStage II, III, and IV) gastric cancers. The 3- and 5-year overall survival rates among patients with GPS of 0 were 63.5% and 53.8%, respectively; the corresponding rates among patients with GPSs of 1 - 2 were 39.3% and 36.8%, respectively. GPS: Glasgow prognostic score.

**Table 1.** Associations of Clinicopathological Characteristics With the Pathological Stage Among Gastric Cancer Cases
	Total, n = 544	pStage I, n = 304	pStage II, III, IV, n = 240	P value
BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score. ^aThe sum of these values does not reach 544 because data were missing for some patients. ^bPatients with grade II or higher postoperative complications (Clavien-Dindo classification) are classified as (+).
Age (years)				< 0.001*
< 75	373	225 (74.0%)	148 (61.7%)
≥ 75	171	79 (26.0%)	92 (38.3%)
Sex				0.276
Male	379	206 (67.8%)	173 (72.1%)
Female	165	98 (32.2%)	67 (27.9%)
BMI (kg/m²)^a				0.007*
< 18	47	20 (6.6%)	27 (11.3%)
≥ 18	496	284 (93.4%)	212 (88.3%)
Comorbidity				0.931
(+)	366	205 (67.4%)	161 (67.1%)
(-)	178	99 (32.6%)	79 (32.9%)
ASA PS				0.116
1, 2	455	261 (85.9%)	194 (80.8%)
3, 4	89	43 (14.1%)	46 (19.2%)
Laboratory data
eGFR (mL/min/1.73 m²)				0.2132
< 60	118	60 (19.7%)	58 (24.2%)
≥ 60	426	244 (80.3%)	182 (75.8%)
Albumin (g/dL)^a				< 0.001*
< 3.5	92	26 (8.6%)	66 (27.5%)
≥ 3.5	434	267 (87.8%)	167 (69.6%)
Lymphocytes (cells/µL)				0.018*
< 1,200	111	51 (16.8%)	60 (25.0%)
≥ 1,200	433	253 (83.2%)	180 (75.0%)
CRP (mg/dL)^a				0.012*
≤ 1.0	496	284 (93.4%)	212 (88.3%)
> 1.0	45	17 (5.6%)	28 (11.7%)
CEA (ng/mL)^a				< 0.001*
≤ 5.0	443	261 (85.9%)	182 (75.8%)
> 5.0	86	31 (10.1%)	55 (22.9%)
CA19-9 (ng/mL)^a				< 0.001*
≤ 37	448	267 (87.8%)	181 (75.4%)
> 37	70	21 (6.9%)	49 (20.4%)
GPS^a				< 0.001*
0	407	252 (82.9%)	155 (64.6%)
1	97	35 (11.5%)	62 (25.8%)
2	20	4 (1.3%)	16 (6.7%)
Macroscopic type				< 0.001*
Type 4	28	1 (0.3%)	27 (11.3%)
Other than type 4	516	303 (99.7%)	213 (88.8%)
Tumor location				< 0.001*
Upper third	169	69 (22.7%)	100 (41.7%)
Middle or lower third	375	235 (77.3%)	140 (58.3%)
Postoperative morbidity^b				< 0.001*
(+)	105	40 (13.2%)	65 (27.1%)
(-)	439	264 (86.8%)	175 (72.9%)

Table 1. Associations of Clinicopathological Characteristics With the Pathological Stage Among Gastric Cancer Cases

Total, n = 544

pStage I, n = 304

pStage II, III, IV, n = 240

P value

BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score. ^aThe sum of these values does not reach 544 because data were missing for some patients. ^bPatients with grade II or higher postoperative complications (Clavien-Dindo classification) are classified as (+).

Age (years)

< 0.001*

< 75

373

225 (74.0%)

148 (61.7%)

≥ 75

171

79 (26.0%)

92 (38.3%)

Sex

0.276

Male

379

206 (67.8%)

173 (72.1%)

Female

165

98 (32.2%)

67 (27.9%)

BMI (kg/m²)^a

0.007*

< 18

20 (6.6%)

27 (11.3%)

≥ 18

496

284 (93.4%)

212 (88.3%)

Comorbidity

0.931

(+)

366

205 (67.4%)

161 (67.1%)

(-)

178

99 (32.6%)

79 (32.9%)

ASA PS

0.116

1, 2

455

261 (85.9%)

194 (80.8%)

3, 4

43 (14.1%)

46 (19.2%)

Laboratory data

eGFR (mL/min/1.73 m²)

0.2132

< 60

118

60 (19.7%)

58 (24.2%)

≥ 60

426

244 (80.3%)

182 (75.8%)

Albumin (g/dL)^a

< 0.001*

< 3.5

26 (8.6%)

66 (27.5%)

≥ 3.5

434

267 (87.8%)

167 (69.6%)

Lymphocytes (cells/µL)

0.018*

< 1,200

111

51 (16.8%)

60 (25.0%)

≥ 1,200

433

253 (83.2%)

180 (75.0%)

CRP (mg/dL)^a

0.012*

≤ 1.0

496

284 (93.4%)

212 (88.3%)

> 1.0

17 (5.6%)

28 (11.7%)

CEA (ng/mL)^a

< 0.001*

≤ 5.0

443

261 (85.9%)

182 (75.8%)

> 5.0

31 (10.1%)

55 (22.9%)

CA19-9 (ng/mL)^a

< 0.001*

≤ 37

448

267 (87.8%)

181 (75.4%)

> 37

21 (6.9%)

49 (20.4%)

GPS^a

< 0.001*

407

252 (82.9%)

155 (64.6%)

35 (11.5%)

62 (25.8%)

4 (1.3%)

16 (6.7%)

Macroscopic type

< 0.001*

Type 4

1 (0.3%)

27 (11.3%)

Other than type 4

516

303 (99.7%)

213 (88.8%)

Tumor location

< 0.001*

Upper third

169

69 (22.7%)

100 (41.7%)

Middle or lower third

375

235 (77.3%)

140 (58.3%)

Postoperative morbidity^b

< 0.001*

(+)

105

40 (13.2%)

65 (27.1%)

(-)

439

264 (86.8%)

175 (72.9%)

**Table 2.** Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival in All Gastric Cancer Patients
Variables	Univariate analysis	Multivariate analysis
HR: hazard ratio; CI: confidence interval; BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score.
Age (≥ 75 vs. < 75 years)	1.621	0.429 - 0.897	0.012*	1.152	0.767 - 1.708	0.491
Sex (male vs. female)	1.363	0.919 - 2.077	0.126
BMI (< 18 vs. ≥ 18 kg/m²)	1.583	0.885 - 2.628	0.116
Comorbidity (+ vs. -)	1.013	0.705 - 1.478	0.944
ASA PS (3, 4 vs. 1, 2)	1.820	1.157 - 2.759	0.011*	1.455	0.891 - 2.301	0.130
eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)	1.062	0.676 - 1.610	0.785
Albumin (< 3.5 vs. ≥ 3.5 g/dL)	2.677	1.776 - 3.944	< 0.001*
Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)	1.198	0.768 - 1.807	0.414
CRP (> 1.0 vs. ≤ 1.0 mg/dL)	2.507	1.491 - 3.988	< 0.001*
CEA (> 5.0 vs. ≤ 5.0 ng/mL)	2.518	1.666 - 3.713	< 0.001*	1.537	0.970 - 2.377	0.067
CA19-9 (> 37 vs. ≤ 37 ng/mL)	2.982	1.938 - 4.460	< 0.001*	2.390	1.475 - 3.768	< 0.001*
GPS (1, 2 vs. 0)	2.928	2.008 - 4.219	< 0.001*	2.462	1.646 - 3.644	< 0.001*
Macroscopic type (type 4 vs. others)	4.521	2.719 - 7.139	< 0.001*	3.613	1.999 - 6.264	< 0.001*
Location (upper vs. middle or lower third)	2.038	1.424 - 2.901	< 0.001*	1.308	0.855 - 1.970	0.212
Postoperative morbidity (+ vs. -)	1.954	1.306 - 2.860	0.002*	1.314	0.845 - 2.001	0.220

Table 2. Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival in All Gastric Cancer Patients

Variables

Univariate analysis

Multivariate analysis

95% CI

P value

95% CI

P value

HR: hazard ratio; CI: confidence interval; BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score.

Age (≥ 75 vs. < 75 years)

1.621

0.429 - 0.897

0.012*

1.152

0.767 - 1.708

0.491

Sex (male vs. female)

1.363

0.919 - 2.077

0.126

BMI (< 18 vs. ≥ 18 kg/m²)

1.583

0.885 - 2.628

0.116

Comorbidity (+ vs. -)

1.013

0.705 - 1.478

0.944

ASA PS (3, 4 vs. 1, 2)

1.820

1.157 - 2.759

0.011*

1.455

0.891 - 2.301

0.130

eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)

1.062

0.676 - 1.610

0.785

Albumin (< 3.5 vs. ≥ 3.5 g/dL)

2.677

1.776 - 3.944

< 0.001*

Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)

1.198

0.768 - 1.807

0.414

CRP (> 1.0 vs. ≤ 1.0 mg/dL)

2.507

1.491 - 3.988

< 0.001*

CEA (> 5.0 vs. ≤ 5.0 ng/mL)

2.518

1.666 - 3.713

< 0.001*

1.537

0.970 - 2.377

0.067

CA19-9 (> 37 vs. ≤ 37 ng/mL)

2.982

1.938 - 4.460

< 0.001*

2.390

1.475 - 3.768

< 0.001*

GPS (1, 2 vs. 0)

2.928

2.008 - 4.219

< 0.001*

2.462

1.646 - 3.644

< 0.001*

Macroscopic type (type 4 vs. others)

4.521

2.719 - 7.139

< 0.001*

3.613

1.999 - 6.264

< 0.001*

Location (upper vs. middle or lower third)

2.038

1.424 - 2.901

< 0.001*

1.308

0.855 - 1.970

0.212

Postoperative morbidity (+ vs. -)

1.954

1.306 - 2.860

0.002*

1.314

0.845 - 2.001

0.220

**Table 3.** Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival in Patients With Stage I Gastric Cancer
Variables	Univariate analysis	Multivariate analysis
HR: hazard ratio; CI: confidence interval; BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score.
Age (≥ 75 vs. < 75 years)	0.984	0.279 - 2.737	0.978
Sex (male vs. female)	1.877	0.681 - 6.587	0.237
BMI (< 18 vs. ≥ 18 kg/m²)	0.643	0.036 - 3.137	0.647
Comorbidity (+ vs. -)	2.122	0.769 - 7.450	0.154
ASA PS (3, 4 vs. 1, 2)	2.663	0.858 - 6.987	0.086	1.971	0.609 - 5.463	0.239
eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)	2.133	0.749 - 5.404	0.146
Albumin (< 3.5 vs. ≥ 3.5 g/dL)	1.351	0.214 - 4.720	0.699
Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)	0.596	0.094 - 2.082	0.459
CRP (> 1.0 vs. ≤ 1.0 mg/dL)	3.676	0.854 - 11.067	0.075
CEA (> 5.0 vs. ≤ 5.0 ng/mL)	0.518	0.029 - 2.516	0.479
CA19-9 (> 37 vs. ≤ 37 ng/mL)	3.824	1.082 - 10.699	0.039*	3.942	1.104 - 11.190	0.037*
GPS (1, 2 vs. 0)	2.765	0.893 - 7.236	0.075	2.682	0.827 - 7.423	0.095
Location (upper vs. middle or lower third)	0.737	0.171 - 2.223	0.616
Postoperative morbidity (+ vs. -)	0.941	0.149 - 3.295	0.935

Table 3. Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival in Patients With Stage I Gastric Cancer

Variables

Univariate analysis

Multivariate analysis

95% CI

P value

95% CI

P value

Age (≥ 75 vs. < 75 years)

0.984

0.279 - 2.737

0.978

Sex (male vs. female)

1.877

0.681 - 6.587

0.237

BMI (< 18 vs. ≥ 18 kg/m²)

0.643

0.036 - 3.137

0.647

Comorbidity (+ vs. -)

2.122

0.769 - 7.450

0.154

ASA PS (3, 4 vs. 1, 2)

2.663

0.858 - 6.987

0.086

1.971

0.609 - 5.463

0.239

eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)

2.133

0.749 - 5.404

0.146

Albumin (< 3.5 vs. ≥ 3.5 g/dL)

1.351

0.214 - 4.720

0.699

Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)

0.596

0.094 - 2.082

0.459

CRP (> 1.0 vs. ≤ 1.0 mg/dL)

3.676

0.854 - 11.067

0.075

CEA (> 5.0 vs. ≤ 5.0 ng/mL)

0.518

0.029 - 2.516

0.479

CA19-9 (> 37 vs. ≤ 37 ng/mL)

3.824

1.082 - 10.699

0.039*

3.942

1.104 - 11.190

0.037*

GPS (1, 2 vs. 0)

2.765

0.893 - 7.236

0.075

2.682

0.827 - 7.423

0.095

Location (upper vs. middle or lower third)

0.737

0.171 - 2.223

0.616

Postoperative morbidity (+ vs. -)

0.941

0.149 - 3.295

0.935

**Table 4.** Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival Among Patients With Stage II, III and IV Gastric Cancer
Variables	Univariate analysis	Multivariate analysis
HR: hazard ratio; CI: confidence interval; BMI: body mass index; ASA PS: American Society of Anesthesiologists physical status; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; CEA: carcinoembryonic antigen; CA19-9: carbohydrate antigen 19-9; GPS: Glasgow prognostic score.
Age (≥ 75 vs. < 75 years)	1.469	0.984 - 2.166	0.060	1.227	0.796 - 1.873	0.350
Sex (male vs. female)	1.145	0.750 - 1.805	0.538
BMI (< 18 vs. ≥ 18 kg/m²)	1.395	0.760 - 2.369	0.266
Comorbidity (+ vs. -)	0.937	0.635 - 1.399	0.746
ASA PS (3, 4 vs. 1, 2)	1.739	1.050 - 2.751	0.033*	1.790	1.054 - 2.918	0.032*
eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)	1.218	0.765 - 2.037	0.417
Albumin (< 3.5 vs. ≥ 3.5 g/dL)	1.701	1.103 - 2.565	0.017*
Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)	1.062	0.665 - 1.638	0.794
CRP (> 1.0 vs. ≤ 1.0 mg/dL)	1.734	0.981 - 2.867	0.058
CEA (> 5.0 vs. ≤ 5.0 ng/mL)	2.114	1.375 - 3.180	<0.001*	1.626	1.017 - 2.545	0.043*
CA19-9 (> 37 vs. ≤ 37 ng/mL)	1.956	1.226 - 3.022	0.006*	1.701	1.013 - 2.777	0.045*
GPS (1, 2 vs. 0)	1.895	1.262 - 2.813	0.002*	1.692	1.101 - 2.577	0.017*
Macroscopic type (type 4 vs. others)	2.064	1.233 - 3.287	0.007*	2.033	1.127 - 3.518	0.020*
Location (upper vs. middle or lower third)	1.555	1.059 - 2.278	0.025*	1.285	0.823 - 1.988	0.267
Postoperative morbidity (+ vs. -)	1.415	0.927 - 2.116	0.106

Table 4. Univariate and Multivariate Analyses of Clinicopathological Variables Associated With Overall Survival Among Patients With Stage II, III and IV Gastric Cancer

Variables

Univariate analysis

Multivariate analysis

95% CI

P value

95% CI

P value

Age (≥ 75 vs. < 75 years)

1.469

0.984 - 2.166

0.060

1.227

0.796 - 1.873

0.350

Sex (male vs. female)

1.145

0.750 - 1.805

0.538

BMI (< 18 vs. ≥ 18 kg/m²)

1.395

0.760 - 2.369

0.266

Comorbidity (+ vs. -)

0.937

0.635 - 1.399

0.746

ASA PS (3, 4 vs. 1, 2)

1.739

1.050 - 2.751

0.033*

1.790

1.054 - 2.918

0.032*

eGFR (< 60 vs. ≥ 60 mL/min/1.73 m²)

1.218

0.765 - 2.037

0.417

Albumin (< 3.5 vs. ≥ 3.5 g/dL)

1.701

1.103 - 2.565

0.017*

Lymphocytes (< 1,200 vs. ≥ 1,200 cells/µL)

1.062

0.665 - 1.638

0.794

CRP (> 1.0 vs. ≤ 1.0 mg/dL)

1.734

0.981 - 2.867

0.058

CEA (> 5.0 vs. ≤ 5.0 ng/mL)

2.114

1.375 - 3.180

<0.001*

1.626

1.017 - 2.545

0.043*

CA19-9 (> 37 vs. ≤ 37 ng/mL)

1.956

1.226 - 3.022

0.006*

1.701

1.013 - 2.777

0.045*

GPS (1, 2 vs. 0)

1.895

1.262 - 2.813

0.002*

1.692

1.101 - 2.577

0.017*

Macroscopic type (type 4 vs. others)

2.064

1.233 - 3.287

0.007*

2.033

1.127 - 3.518

0.020*

Location (upper vs. middle or lower third)

1.555

1.059 - 2.278

0.025*

1.285

0.823 - 1.988

0.267

Postoperative morbidity (+ vs. -)

1.415

0.927 - 2.116

0.106