Abstract
Objective
To evaluate the relationship between dynamic changes in the modified Glasgow Prognostic
Scale (mGPS) and postnephrectomy survival among localized clear cell renal cell carcinoma
(ccRCC) patients.
Methods
We retrospectively identified patients who underwent nephrectomy for localized ccRCC
with preoperative mGPS = 0 from 2005 to 2018. The primary exposure of interest was
ΔmGPS between 2 points – 60 days prior to surgery and 1 year after surgery. We assessed
the relationship between ΔmGPS and survival outcomes. Kaplan-Meier curves were generated
to determine survival estimates and Cox proportional hazards models were fit to estimate
hazard ratios (HRs). Multivariable models were constructed using both ΔmGPS and clinical
variables known to be associated with differences in survival.
Results
We identified 313 patients for our analytic cohort with a median follow-up time of
20.2 months. Thirty-seven (11.9%) patients died and 39 (12.54%) showed recurrence
during follow-up. Two hundred sixty-three (84.6%) patients had unchanged mGPS before
and after surgery, while 48 (15.4%) patients showed an increase in postoperative mGPS
from preoperative mGPS. Compared to patients with unchanged mGPS, patients with a
higher postoperative mGPS had an increased risk of death (HR = 3.05 [1.39-6.68], P = .005) and recurrence (HR = 2.98 [1.34-6.64], P = .008).
Conclusion
Patients with an increase in mGPS following nephrectomy for ccRCC were more likely
to die and experience cancer recurrence. Assessing dynamic changes in this cheap,
validated, and reproducible test may be useful in identifying patients at higher risk
for more aggressive disease or for counseling patients regarding risk of cancer recurrence.
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Article info
Publication history
Published online: April 12, 2020
Accepted:
March 22,
2020
Received:
November 21,
2019
Footnotes
Financial Disclosure: We gratefully acknowledge support from the John Robinson Family Foundation and the Chris Churchill Kidney Cancer Foundation.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
