Presentation Authors: Dattatraya Patil*, KC Biebighauser Bens, Mehrdad Alemozaffar, Aaron Lay, Mehmet Bilen, John Pattaras, Christopher Filson, Kenneth Ogan, Viraj Master, Atlanta, GA
Introduction: The inflammation-based modified Glasgow Prognostic Score (mGPS) is widely used as a prognostic indicator before surgery; however, little information is available on its benefit in postoperative patients with regards to its relative change from initial preoperative value. We evaluated the usefulness of the mGPS change from before to after surgery as a prognostic factor in patients with low risk localized clear cell renal cell carcinoma (ccRCC).
Methods: We retrospectively identified patients who underwent nephrectomy for ccRCC with preoperative mGPS=0 from 2005 to 2018. Patients with pathologic T4 or metastatic disease were excluded. Preoperative mGPS was determined within 60 days prior to surgery, and postoperative mGPS at 1 year after surgery. Change from preoperative to postoperative mGPS was assessed for association with overall or recurrence free survival. Kaplan-meier curve was used to determine survival estimates. Univariable and multivariable COX proportional hazards were used to estimate hazard ratios. Multivariable models were adjusted for age, sex, BMI, ECOG status, T-stage, RCC grade, and presence of necrotic tissue along with mGPS change.
Results: 312 patients with ccRCC and preoperative mGPS=0 treated with nephrectomy were identified. 216 (69.2%) had pathologic T1 disease, 21 (6.7%) T2 disease, and 75 (24%) T3 disease. Overall, 24 (7.7%) patients died and 38 (12.2%) showed recurrence during follow up. 266 (85.3%) patients had unchanged mGPS before and after surgery, while 46 (14.7%) patients showed an increase in postoperative mGPS from preoperative mGPS. Compared to patients with unchanged mGPS, patients with higher postoperative mGPS had an increased risk of death (HR: 7.07, 95%CI: 2.62-19.05, p < .001) and recurrence (HR: 2.99, 95%CI: 1.30-6.89, p=0.01), while adjusting for age, stage, grade, necrosis, ECOG, BMI, and sex.
Conclusions: Modified Glasgow Prognostic Score (mGPS) dynamics from preoperative to postoperative is an independent and significant predictor of overall and recurrence free survival in low risk localized ccRCC. mGPS is calculated from standardized laboratory markers that can be easily and cost-effectively obtained at any time, and change over time can be used as a prognostic indicator.
Source of Funding: The Robinson and Churchill Family Foundation