Diagnostics (Feb 2022)

Modified Glasgow Prognostic Score as a Predictor of Recurrence in Patients with High Grade Non-Muscle Invasive Bladder Cancer Undergoing Intravesical Bacillus Calmette–Guerin Immunotherapy

  • Matteo Ferro,
  • Octavian Sabin Tătaru,
  • Gennaro Musi,
  • Giuseppe Lucarelli,
  • Abdal Rahman Abu Farhan,
  • Francesco Cantiello,
  • Rocco Damiano,
  • Rodolfo Hurle,
  • Roberto Contieri,
  • Gian Maria Busetto,
  • Giuseppe Carrieri,
  • Luigi Cormio,
  • Francesco Del Giudice,
  • Alessandro Sciarra,
  • Sisto Perdonà,
  • Marco Borghesi,
  • Carlo Terrone,
  • Evelina La Civita,
  • Pierluigi Bove,
  • Riccardo Autorino,
  • Matteo Muto,
  • Nicolae Crisan,
  • Michele Marchioni,
  • Luigi Schips,
  • Francesco Soria,
  • Daniela Terracciano,
  • Rocco Papalia,
  • Felice Crocetto,
  • Biagio Barone,
  • Giorgio Ivan Russo,
  • Stefano Luzzago,
  • Giuseppe Mario Ludovico,
  • Mihai Dorin Vartolomei,
  • Francesco Alessandro Mistretta,
  • Vincenzo Mirone,
  • Ottavio de Cobelli

DOI
https://doi.org/10.3390/diagnostics12030586
Journal volume & issue
Vol. 12, no. 3
p. 586

Abstract

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Background: A systemic inflammatory marker, the modified Glasgow prognostic score (mGPS), could predict outcomes in non-muscle-invasive bladder cancer (NIMBC). We aimed to investigate the predictive power of mGPS in oncological outcomes in HG/G3 T1 NMIBC patients undergoing Bacillus Calmette–Guérin (BCG) therapy. Methods: We retrospectively reviewed patient’s medical data from multicenter institutions. A total of 1382 patients with HG/G3 T1 NMIBC have been administered adjuvant intravesical BCG therapy, every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months. The analysis of mGPS for recurrence and progression was performed using multivariable and univariable Cox regression models. Results: During follow-up, 659 patients (47.68%) suffered recurrence, 441 (31.91%) suffered progression, 156 (11.28%) died of all causes, and 67 (4.84%) died of bladder cancer. At multivariable analysis, neutrophil to lymphocyte ratio [hazard ratio (HR): 7.471; p = 0.0001] and erythrocyte sedimentation rate (ESR) (HR: 0.706; p = 0.006 were significantly associated with recurrence. mGPS has no statistical significance for progression (p = 0.076). Kaplan–Meier survival analysis showed a significant difference in survival among patients from different mGPS subgroups. Five-year OS was 93% (CI 95% 92–94), in patients with mGPS 0, 82.2% (CI 95% 78.9–85.5) in patients with mGPS 1 and 78.1% (CI 95% 60.4–70) in mGPS 2 patients. Five-year CSS was 98% (CI 95% 97–99) in patients with mGPS 0, 90% (CI 95% 87–94) in patients with mGPS 1, and 100% in mGPS 2 patients. Limitations are applicable to a retrospective study. Conclusions: mGPS may have the potential to predict recurrence in HG/G3 T1 NMIBC patients, but more prospective, with large cohorts, studies are needed to study the influence of systemic inflammatory markers in prediction of outcomes in NMIBC for a definitive conclusion.

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