External Validation Of The Glasgow Prognostic Score (Mgps) For Renal Cancer.

378 Background: Inflammation has been termed the 7(th) hallmark of cancer (Hanahan and Weinberg Cell 2011). Measurement of systemic inflammatory responses in malignancy is possible using a selective combination of two commonly available, cost-effective serum assays. The combination of these two serum markers, C-reactive protein (CRP) and albumin, is termed the modified Glasgow prognostic score (mGPS), and is strongly correlated with outcome in a variety of cancers, including mRCC. Recently, mGPS has been shown to be predictive of outcome in localized RCC (ASCO GU 2010 #390). We sought to externally validate these results.Nephrectomized patients with clinically localized (T1-T4N0M0) clear cell RCC with negative surgical margins were followed for a mean of 25 months (range: 1-81 months). Relapse and survival was identified through routine follow-up. Patients were categorized by mGPS score as Low Risk (mGPS = 0 points), Intermediate Risk (mGPS = 1 point), and High Risk (mGPS = 2 points). One point was assigned to patients for an elevated CRP (>10 mg/L) and hypoalbuminemia (<3.5 mg/dL). Patients with normal CRP and hypoalbuminemia were assigned 0 points. Kaplan-Meier and multivariate Cox regression analyses examined relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics.Of 248 patients, 17.9% relapsed and 18.6% died. Of Low, Intermediate, and High Risk patients, 7.2%, 7.7%, and 45.5%, respectively relapsed and 5.2%, 15.4%, and 39.4%, respectively died during the study. In multivariate analysis including stage and grade, mGPS was significantly associated with RFS and OS. Compared to Low-Risk patients, High-Risk patients experienced a 3-fold (OR: 2.906, 95% CI: 1.055-8.001) increased risk of relapse and 4-fold (HR: 3.722, 95% CI: 1.046-13.245) increased risk of mortality. AUC is 0.813, which compares very favorably to existing prognostic algorithms.In this external validation cohort of US patients, mGPS continues to be a predictor of relapse and overall mortality following nephrectomy for localized RCC. Clinicians may consider using mGPS as an adjunct to identify high-risk patients for possible enrollment into clinical trials, or for patient counseling.