Clinical utility of the modified Glasgow prognostic score in lung cancer: A meta-analysis

Objective To perform a meta-analysis of prospective and retrospective studies exploring the association of the modified Glasgow prognostic score (mGPS) with overall survival (OS) in patients with lung cancer. Methods Relevant studies were identified by searching the Cochrane Library, Web of Science, Embase and PubMed until April 16, 2017. We combined hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between mGPS and OS in patients with lung cancer. Results Eleven studies involving 5817 participants from several countries were included in the meta-analysis. In a pooled analysis of all studies, elevated mGPS predicted poorer OS (HR = 1.77; 95% CI: 1.35–2.31; P<0.05). Subgroup analyses stratified by mGPS showed that mGPS of 1 or 2 and mGPS≥1 were predictive of poorer OS and that the HR for mGPS of 2 (HR = 5.82; 95% CI: 1.85–18.22; P = 0.003) was significantly greater than that for mGPS of 1 (HR = 1.74; 95% CI: 1.24–2.45; P = 0.001) and mGPS≥1 (HR = 1.42; 95% CI: 1.14–1.76; P = 0.002). Among patients undergoing surgery, elevated mGPS had a non-significant correlation with reduced OS (HR = 2.48; 95% CI: 0.90–6.85; P = 0.079), whereas the correlation was significant for patients receiving chemotherapy or other palliative treatment (HR = 1.74; 95% CI: 1.31–2.30; P<0.05). Conclusions Our findings indicate that mGPS may have prognostic value in lung cancer, as we detected a significant association between elevated mGPS and poorer OS. The association between mGPS and poorer OS was non-significant among patients undergoing surgery, which may be attributable to lower tumor load. However, further studies are warranted to draw firm conclusions.