*5.2.3. Presence of distant metastases: M*

In a homogeneous group of 88 gastric cancer patients undergoing only surgical treatment, increasing GPS was associated with presence of synchronous distant metastases and venous invasion [96].

#### Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications... http://dx.doi.org/10.5772/intechopen.69723 175


lower level of albumin, elevated concentration of C-reactive protein, high absolute number of neutrophilic leukocytes and elevated NLR). In multivariate analysis, modified Glasgow prognostic score was identified as an independent prognostic factor along with NLR, presence of lymph node metastasis and histological subtype [69]. In 68 patients affected by advanced gastric cancer and treated by chemotherapy with or without irradiation, high GPS predicted shorter survival [103]. High GPS was an independent prognostic factor in 384 inoperable advanced or metastatic gastric cancer patients treated with chemotherapy. The value of GPS was higher than that of NLR, PLR or CRP [68]. In 125 patients with recurrent or metastatic gastric cancer placed on single agent chemotherapy because of poor performance status, GPS had independent prognostic value [104]. In 91 metastatic or recurrent gastric cancer patients treated by palliative chemotherapy, GPS was significantly associated with survival. The differences were also biologically remarkable: the median survival was 12.3 months if GPS was

Recently, a meta-analysis was carried out including 14 studies and 5579 gastric cancer patients. High GPS was significantly associated with poor overall survival (hazard ratio 1.51; 95% CI 1.37– 1.66), and disease-free survival (HR 1.45; 95% CI = 1.26–1.68) as reported by Zhang et al. [106].

Glasgow prognostic score has been further developed into different complex scores. Thus, complex predictive score regarding survival was elaborated, based on NLR and modified Glasgow prognostic score in patients with metastatic gastric adenocarcinoma treated by chemotherapy, after independent prognostic value of both parameters was justified in a group of 256 patients [26]. The design of studies devoted to GPS in gastric carcinoma is summarised in **Table 5**.

In 88 patients undergoing only surgical treatment, increasing GPS was associated with higher T and resection line status [96]. In a recent meta-analysis, association between high GPS and high TNM stage was found. Although the association with lymph node metastases (OR 4.60;

In a recent meta-analysis including 14 studies and 5579 gastric cancer patients, high GPS was significantly associated with presence of lymph node metastases (OR 4.60; 95% CI = 3.23–6.56)

In a homogeneous group of 88 gastric cancer patients undergoing only surgical treatment, increasing GPS was associated with presence of synchronous distant metastases and venous

95% CI = 3.23–6.56) was significant, there was no association with T [106].

as well as with lymphatic (OR 3.04; 95% CI = 2.00–4.62) invasion [106].

0 but only 2.9 if GPS was 2 [105].

174 Gastric Cancer

**5.2. Association with tumour features**

*5.2.2. Metastases in regional lymph nodes: N*

*5.2.3. Presence of distant metastases: M*

invasion [96].

*5.2.1. Local tumour spread: T*


Abbreviations: GC, gastric cancer; mGPS, modified Glasgow prognostic score; OS, overall survival; GPS, Glasgow prognostic score; T, local tumour spread by tumour-nodes-metastasis (TNM) classification; M, presence of distant metastasis by TNM classification; R, resection line status; CEA, carcinoembryonic protein; HS-GPS, high sensitivity Glasgow prognostic score; CFS, cancer-free survival; CSS; cancer-free survival; PFS, progression-free survival; TNM, tumour-nodes-metastasis classification; vs, versus; N, regional lymph node status by TNM classification.

**Table 5.** The design of studies devoted to Glasgow prognostic score in gastric cancer.
