Modified Glasgow prognostic score as a prognostic factor for renal cell carcinomas: a systematic review and meta-analysis

Figures & data

Figure 1 Flowchart of literature search.

Table 1 Characteristics of include studies

Study/published year	Enrollment date/location	Study type	Treatment	Number of patients	Age median (range) years	Tumor	mGPS	Outcomes	Follow-up median range (months)	NOS
Tsujino 2017	2005 and 2015/Japan	Retrospective	Nephrectomy	219	mean ± SD 65.0±10.8	RCC	0: 184 (84.0%) 1: 20 (9.1%) 2: 15 (6.9%)	OS CSS	Median:57	8
Ohmura 2017	October 2009 and August 2015/Japan	Retrospective	Molecular-targeted drug	32	66 (33–82)	Advanced RCC	0: 21 (65.6%) 1: 3 (9.4%) 2: 8 (25.0%)	OS PFS	NA	7
Lorentz 2017	2006 and 2016/US	NA	Nephrectomy and IVC tumor thrombectomy	117	NA	ccRCC with IVC thrombus	0: 38 (32.3%) 1: 17 (14.4%) 2: 62 (53.3%)	OS	Median (IQR) 12.6 (4.8–32.4)	Conference
Harris 2017	2005 and 2015/US	Retrospective	Targeted agent	181	64 (26–89)	mRCC	0: 92 (50.8%) 1: 36 (19.9%) 2: 53 (29.3%)	OS	NA	7
Ishihara 2016	2007 and 2014/Japan	Retrospective	First-Line Sunitinib	71	64.0 (31–79)	mRCC	0: 53 (74.6%) 1: 10 (14.1%) 2: 8 (11.3%)	OS PFS	17.0 (2.24–65.6)	8
Cho 2016	June 1994 and July 2012/Korea	Retrospective	Radical or partial nephrectomy	388	Mean(Range) 56.0 (18–81)	Non-metastatic ccRCC	0: 327 (84.3%) 1: 38 (9.8%) 2: 23 (5.9%)	CSS RFS	44 (4–215)	8
Chen 2015	2003 to 2012/China	Retrospective	Radical or partial nephrectomy	406	Mean(Range) 58(24–80)	ccRCC	NA	OS	Mean (range) 63 (1–151)	7
Baum 2015	2005 and 2013/US	NA	Nephrectomy	352	Mean 58.8	Localized ccRCC	0: 267 (75.8%) 1: 38 (10.8%) 2: 47 (13.3%)	OS	Mean (range) 31.6 (0.03–84)	Conference
Tai 2014	November 2006 and January 2008/US	Prospective	Radical nephrectomy	129	Median(IQR) 62.0(54.0–70.0)	Localized ccRCC	0: 80 (62.0%) 1: 27 (20.9%) 2: 22 (17.1%)	RFS	Median (IQR) 25.5 (12.0–32.4)	7
Qayyum 2012	UK	Prospective	Nephrectomy	79	60(39–82)	ccRCC	0: 57 (72.2%) 1: 19 (24.0%) 2: 3 (3.8%)	CSS	93 (0.1–152)	7
Lamb 2012	March 1997 and July 2007/UK	Prospective	Nephrectomy	169	NA	ccRCC	0: 117 (69.2%) 1: 46 (27.2%) 2: 6 (3.6%)	OS CSS	Median (minimum) 98 (49)	8
Cross 2012	US	NA	Nephrectomy	248	NA	Localized ccRCC	NA	OS RFS	Mean (range) 25 (1–81)	Conference

Abbreviations: mGPS, modified Glasgow prognostic score; NOS, Newcastle–Ottawa Quality Assessment Scale; IQR, interquartile range; RCC, renal cell carcinoma; mRCC, metastatic renal cell carcinoma; ccRCC, clear cell renal cell carcinoma; OS, overall survival; CSS, cancer-specific survival; RFS, recurrence-free survival; PFS, progression-free survival; IVC, inferior vena cava; NA, not available.

Figure 2 Association between mGPS and OS in patients with renal cell carcinoma.

Abbreviations: HR, hazard ratio; CI, confidence interval; mGPS, modified Glasgow prognostic score; OS, overall survival.

Figure 3 Association between mGPS and CSS in patients with renal cell carcinoma.

Abbreviations: HR, hazard ratio; CI, confidence interval; mGPS, modified Glasgow prognostic score; CSS, cancer-specific survival.

Figure 4 Association between mGPS and RFS in patients with renal cell carcinoma.

Abbreviations: HR, hazard ratio; CI, confidence interval; mGPS, modified Glasgow prognostic score; RFS, recurrence-free survival.

Figure 5 Association between mGPS and PFS in patients with renal cell carcinoma.

Abbreviations: HR, hazard ratio; CI, confidence interval; mGPS, modified Glasgow prognostic score; PFS, progression-free survival.

Figure 6 Sensitivity analyses of the association between mGPS and OS (A), CSS (B), and RFS (C) in patients with renal cell carcinoma.

Abbreviations: CI, confidence interval; mGPS, modified Glasgow prognostic score; OS, overall survival; CSS, cancer-specific survival; RFS, recurrence-free survival.

Table 2 Subgroup analyses for OS and CSS

Outcome	Variable	Number of studies	Model	HR (95%CI)	I^2	P-value of heterogeneity
OS	All	9	Random	4.31 (2.78–6.68)	60.6%	P=0.005
Pathology	Clear cell	5	Random	3.54 (2.48–5.06)	0%	P=0.677
	All	4	Random	5.95 (2.46–14.39)	78.2%	P<0.001
Cutoff	1	3	Random	3.01 (2.04–4.44)	23.8%	P=0.268
	2	6	Random	5.76 (2.86–11.63)	64.4%	P=0.010
Stage	Localized	3	Random	3.93 (2.13–7.27)	0%	P=0.891
	Advanced/metastatic	5	Random	5.72 (2.43–13.46)	78.0%	P<0.001
	All	2	Random	3.09 (1.49–6.43)	54.2%	P=0.139
Regions	Asia	4	Random	2.87 (1.69–4.86)	40.0%	P=0.154
	Western	5	Random	5.78 (3.24–10.30)	54.3%	P=0.053
CSS	All	4	Fixed	5.88 (3.93–8.78)	0%	P=0.521
Pathology	Clear cell	3	Fixed	5.99 (3.94–9.09)	7.4%	P=0.340
	All	1	Fixed	4.69 (1.09–20.20)	-	-
Stage	Localized	2	Fixed	3.91 (1.94–7.86)	0%	P=0.781
	All	2	Fixed	7.18 (4.40–11.73)	0%	P=0.633
Regions	Asia	2	Fixed	3.91 (1.94–7.86)	0%	P=0.781
	Western	2	Fixed	7.18 (4.40–11.73)	0%	P=0.633

Abbreviations: OS, overall survival; CSS, cancer-specific survival; HR, hazard ratio; CI, confidence interval.