The modified Glasgow prognostic score (MGPS) and the mortality prediction model II (MPM II) can predict mortality in patients with breast cancer admitted to intensive care: A retrospective cohort study: Inflammation markers in breast cancer patients in intensive care

Burcu Tunay; Omer Fatih Olmez; Ahmet Bilici; Ayberk Bayramgil; Gunes Dorukhan  Cavusoglu; Huseyin Oz

doi:10.28982/josam.7606

Authors

Burcu Tunay Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0002-0383-7792
Omer Fatih Olmez Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0001-7934-7039
Ahmet Bilici Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0002-0443-6966
Ayberk Bayramgil Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0003-1782-7808
Gunes Dorukhan Cavusoglu Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0001-8914-7911
Huseyin Oz Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey https://orcid.org/0000-0002-6512-4931

DOI:

https://doi.org/10.28982/josam.7606

Keywords:

breast cancer, inflammation, clinical scoring, mortality, intensive care unit

Abstract

Background/Aim: Breast cancer is the second most common cause of cancer-related death in women worldwide. Predicting the prognosis in breast cancer with very high mortality is important in terms of disease treatment and increasing life expectancy. In our study, we aimed to examine the importance of some inflammatory markers and scoring systems in predicting prognosis in patients with breast cancer who were hospitalized in the intensive care unit.

Methods: This retrospective cohort study was conducted in the Department of Medical Oncology and Intensive Care Unit between 2014 and 2020. Breast cancer patients who were admitted to the intensive care unit at any stage of their treatment during the study and followed up and treated in the medical oncology department of the hospital were included in the study. All data were compared between groups (discharged or exitus) based on survival status. Socio-demographic information, laboratory findings (hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, eosinophils, monocytes, C-reactive protein [CRP], albumin, lactate dehydrogenase [LDH], clinical status [co-morbidities, length of stay in intensive care, mechanical ventilation, and reason for hospitalization in the intensive care unit]), and survival data of the patients were collected retrospectively from hospital medical records. We also recorded treatment-related data and relapse/progression information. Neutrophil–lymphocyte, platelet–lymphocyte, and lymphocyte–monocyte ratios (NLR, PLR, and LMR, respectively) were calculated.

Results: Thirty-seven (52.1%) patients died and 34 (47.9%) patients survived. The NLR (P=0.021), Modified Glasgow Prognostic score (P<0.001), APACHE II score (P<0.001) and mortality probability model (MPM II) upon admission (P<0.001) were significantly higher in the exitus group than in the survivors. The lymphocyte_monocyte ratio (P=0.030) and prognostic nutritional index (P=0.004) were significantly higher in the discharged group than in the death group. When we evaluated performance of the prognostic scores to predict mortality, we found that the APACHE II score (area under the curve [AUC]: 0.939, 95% confidence interval [CI]: 0.888–0.990), MPM II-Admission (AUC: 0.936, 95% CI: 0.880–0.992), and modified Glasgow Prognostic Score ([mGPS] AUC: 0.727, 95% CI: 0.600–0.854) had the highest area under curve values. Multivariable regression revealed that longer chemotherapy duration (≥2 weeks), an mGPS score of two points, and high MPM-II (≥36 points) were independently associated with mortality.

Conclusion: Among the inflammatory markers and scores examined, mGPS and MPM-II were found to be independently associated with mortality in breast cancer patients who were hospitalized in the intensive care unit. In addition, patients with longer chemotherapy duration had a higher risk of mortality, but this result was limited by various possible confounders.

Downloads

Download data is not yet available.

References

Howell A, Anderson AS, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, et al. Risk determination and prevention of breast cancer. Breast Cancer Res. 2014;16(5):1-19. DOI: https://doi.org/10.1186/s13058-014-0446-2

WHO. Fact Sheets. Breast Cancer. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer [Last accessed on 2021 Dec 04].

Türkiye Kanser İstatistikleri 2017. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Ankara 2021. Available from: https://hsgm.saglik.gov.tr/tr/kanser-istatistikleri [Last accessed on 2021 Dec 04].

Colditz GA, Bohlke K. Priorities for the primary prevention of breast cancer. CA Cancer J Clin. 2014 May-Jun;64(3):186-94. DOI: https://doi.org/10.3322/caac.21225

Mackillop W. The importance of prognosis in cancer medicine. In: Gospodarowicz M, editor. Prognostic factors in cancer. 2nd ed. New York: Wiley; 2001.

Mleko, M, Pitynski, K, Pluta, E, Czerw, A, Sygit, K, Karakiewicz, B, et al. Role of Systemic Inflammatory Reaction in Female Genital Organ Malignancies - State of the Art. Cancer Manag. Res. 2021;13:5491–508. doi: 10.2147/CMAR.S312828. PMID: 34276227; PMCID: PMC8277565. DOI: https://doi.org/10.2147/CMAR.S312828

Mandaliya H, Jones M, Oldmeadow C, Nordman II. Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI). Transl Lung Cancer Res. 2019 Dec;8(6):886-94. doi: 10.21037/tlcr.2019.11.16. PMID: 32010567; PMCID: PMC6976360. DOI: https://doi.org/10.21037/tlcr.2019.11.16

Cupp M.A, Cariolou M, Tzoulaki I, Aune D, Evangelou E, Berlanga-Taylor A.J. Neutrophil to lymphocyte ratio and cancer prognosis: An umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020;18:360. DOI: https://doi.org/10.1186/s12916-020-01817-1

Howard R, Kanetsky PA, Egan KM. Exploring the prognostic value of the neutrophil-to-lymphocyte ratio in cancer. Sci Rep. 2019;9:19673. DOI: https://doi.org/10.1038/s41598-019-56218-z

Al Murri AM, Bartlett JM, Canney PA, Doughty JC, Wilson C, McMillan DC. Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer. 2006;94:227–230. DOI: https://doi.org/10.1038/sj.bjc.6602922

Ethier JL, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2017;19(1):2. DOI: https://doi.org/10.1186/s13058-016-0794-1

Corbeau I, Jacot W, Guiu S. Neutrophil to lymphocyte ratio as prognostic and predictive factor in breast cancer patients: a systematic review. Cancers. 2020;12(4):958. DOI: https://doi.org/10.3390/cancers12040958

Cho U, Park HS, Im SY, Yoo CY, Jung JH, Suh YJ, et al. Prognostic value of systemic inflammatory markers and development of a nomogram in breast cancer. PLoS One. 2018;13(7):e0200936. DOI: https://doi.org/10.1371/journal.pone.0200936

Zhang Y, Sun Y, Zhang Q. Prognostic value of the systemic immune-inflammation index in patients with breast cancer: a meta-analysis.Cancer Cell Int. 2020;20:224. DOI: https://doi.org/10.1186/s12935-020-01308-6

Mohri T, Mohri Y, Shigemori T, Takeuchi K, Itoh Y, Kato T. Impact of prognostic nutritional index on long-term outcomes in patients with breast cancer. World J Surg Oncol. 2016 27;14(1):170. DOI: https://doi.org/10.1186/s12957-016-0920-7

Headley J, Theriault R, Smith TL. Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit. Cancer. 1992 Jul 15;70(2):497-503. DOI: https://doi.org/10.1002/1097-0142(19920715)70:2<497::AID-CNCR2820700220>3.0.CO;2-H

Siddiqui SS, Narkhede AM, Kulkarni AP, Prabu NR, Chaudhari HK, Sarode SV, et al. Evaluation and Validation of Four Scoring Systems: the APACHE IV, SAPS III, MPM0 II, and ICMM in Critically Ill Cancer Patients. Indian Journal of Critical Care Medicine. 2020;24(4):264-9. DOI: https://doi.org/10.5005/jp-journals-10071-23407

Hirashima K, Watanabe M, Shigaki H, Imamura Y, Ida S, Iwatsuki M, et al. Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer. J Gastroenterol 2014;49:1040–6. DOI: https://doi.org/10.1007/s00535-013-0855-5

Liu JX, Shi ZZ, Bai YS, Liu L, Cheng KL. Prognostic significance of systemic immune-inflammation index in triple-negative breast cancer. Cancer Manag Res. 2019;11:4471–80. DOI: https://doi.org/10.2147/CMAR.S197623

Pinato, D, North, B. & Sharma, R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer. 2012;106:1439–45. DOI: https://doi.org/10.1038/bjc.2012.92

Miao J, Xiao W, Wang L, Han F, Wu H, Deng X, et al. The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT). J Cancer Res Clin Oncol. 2017 Jul;143(7):1263-73. doi: 10.1007/s00432-017-2360-3. Epub 2017 Feb 28. PMID: 28247035. DOI: https://doi.org/10.1007/s00432-017-2360-3

Yang Z, Zhang B, Hou L, Xie Y, Cao X. Pre-operative prognostic nutritional index predicts the outcomes for triple-negative breast cancer. Tumour Biol. 2014;35:12165–71. DOI: https://doi.org/10.1007/s13277-014-2524-6

Zhang H, Shang X, Ren P, Gong L, Ahmed A, Ma Z, et al. The predictive value of a preoperative systemic immune-inflammation index and prognostic nutritional index in patients with esophageal squamous cell carcinoma. J Cell Physiol. 2019;234:1794–802. DOI: https://doi.org/10.1002/jcp.27052

Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270(20):2478-86. DOI: https://doi.org/10.1001/jama.270.20.2478

Knaus WA, Draper EA, Wagner DP, Wagner DP. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818-29. DOI: https://doi.org/10.1097/00003246-198510000-00009

Akyol M, Demir L, Alacacioglu A, Ellidokuz H, Kucukzeybek Y, Yildiz Y, et al. The effects of adjuvant endocrine treatment on serum leptin, serum adiponectin and body composition in patients with breast cancer: the Izmir Oncology Group (IZOG) Study. Chemotherapy. 2015;61:57–64. DOI: https://doi.org/10.1159/000440944

Han Y, Mao F, Wu Y, Fu X, Zhu X, Zhou S, et al. Prognostic role of c‐reactive protein in breast cancer: A systematic review and meta‐analysis. Int J Biol Markers. 2011;26:209–15. DOI: https://doi.org/10.5301/JBM.2011.8872

Crumley AB, McMillan DC, McKernan M, McDonald AC, Stuart RC. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer. 2006;94:637–41. DOI: https://doi.org/10.1038/sj.bjc.6602998

Oñate-Ocaña LF, Aiello-Crocifoglio V, Gallardo-Rincón D, Herrera-Goepfert R, Brom-Valladares R, Carrillo JF, et al. Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Ann Surg Oncol. 2007;14:381–9. DOI: https://doi.org/10.1245/s10434-006-9093-x

Lis CG, Grutsch JF, Vashi PG, Lammersfeld CA. Is albumin an independent predictor of survival in patients with breast cancer? J Parenter Enteral Nutr. 2003;27:10–5. DOI: https://doi.org/10.1177/014860710302700110

Wang D, Duan L, Tu Z, Yan F, Zhang C, Li X, et al. The Glasgow Prognostic Score Predicts Response to Chemotherapy in Patients with Metastatic Breast Cancer. Chemotherapy. 2016;61:217–22. DOI: https://doi.org/10.1159/000443367

Zhang H, Ren D, Jin X, Wu H. The prognostic value of modified Glasgow Prognostic Score in pancreatic cancer: a meta-analysis. Cancer Cell Int. 2020;20:462. DOI: https://doi.org/10.1186/s12935-020-01558-4

Yotsukura M, Ohtsuka T, Kaseda K, Kamiyama I, Hayashi Y, Asamura H. Value of the Glasgow Prognostic Score as a Prognostic Factor in Resectable Non–Small Cell Lung Cancer. Journal of Thoracic Oncology. 2016;11(8):1311-8. DOI: https://doi.org/10.1016/j.jtho.2016.04.029

Nozoe T, Matono R, Ijichi H, Ohga T, Ezaki T. Glasgow Prognostic Score (GPS) Can Be a Useful Indicator to Determine Prognosis of Patients with Colorectal Carcinoma. Int Surg. 2014;99:512–7. DOI: https://doi.org/10.9738/INTSURG-D-13-00118.1

Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, Kramer AA. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Crit Care Med. 2007 Mar;35(3):827-35. DOI: https://doi.org/10.1097/01.CCM.0000257337.63529.9F

Arabi Y, Al Shirawi N, Memish Z, Venkatesh S, Al-Shimemeri A. Assessment of six mortality prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study. Crit Care. 2003;7(5): R116-22. DOI: https://doi.org/10.1186/cc2373

Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, et al. Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Critical Care. 2004;8:R194-203. DOI: https://doi.org/10.1186/cc2870

Zhu Y, Si W, Sun Q, Qin B, Zhao W, Yang J. Platelet-lymphocyte ratio acts as an indicator of poor prognosis in patients with breast cancer. Oncotarget. 2017;8(1):1023-30. DOI: https://doi.org/10.18632/oncotarget.13714

Ma Y, Zhang J, Chen X. Lymphocyte-to-Monocyte Ratio is Associated with the Poor Prognosis of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Cancer Manag Res. 2021 Feb 16;13:1571-80. DOI: https://doi.org/10.2147/CMAR.S292048

Jiang C, Lu Y, Zhang S, Huang Y. Systemic Immune-Inflammation Index Is Superior to Neutrophil to Lymphocyte Ratio in Prognostic Assessment of Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy. Biomed Res Int. 2020;2020:7961568. DOI: https://doi.org/10.1155/2020/7961568

Wang Y, Battseren B, Yin W, Lin Y, Zhou L, Yang F, et al. Predictive and prognostic value of prognostic nutritional index for locally advanced breast cancer. Gland Surg. 2019;8(6):618-26. DOI: https://doi.org/10.21037/gs.2019.10.08