Systemic inflammation and survival of patients with prostate cancer: evidence from the Glasgow Inflammation Outcome Study

BACKGROUND: There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer; however, it is unclear whether this is independent of grade. We therefore investigated the role of inflammation-based prognostic scores, the modified Glasgow Prognostic Score (mGPS) and neutrophil lymphocyte ratio (NLR), and their associations with Gleason grade in patients with prostate cancer. METHODS: Patients from a cohort, the Glasgow Inflammation Outcome Study, who had diagnosis of prostate cancer, were included in this study. The mGPS was constructed by combining C-reactive protein and albumin whereas NLR by calculating the ratio of neutrophils to lymphocytes. We estimated 5-year relative survival and relative excess risk (RER) of death by mGPS and NLR categories after adjusting for age, socioeconomic circumstances and Gleason grade. RESULTS: In all, 897 prostate cancer patients were identified; of those 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation appeared to have significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socioeconomic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: RER = 2.41, 95% confidence interval 1.37-4.23) among aggressive, clinically significant prostate cancer (Gleason grades 8-10). CONCLUSIONS: The mGPS is a strong measure of systemic inflammation, when compared with NLR. Prostate cancer patients with a raised mGPS had significantly higher risk of death for overall as well high-grade disease. Inflammation-based prognostic scores predict outcome in patients with prostate cancer and should be added to their routine clinical assessment.