The modified Glasgow prognostic score as inflammation-based nutritional assessment for systemic treatment tolerance in patients with colorectal cancer

Background and aims: Malnutrition is an important predictor of chemotherapy-related toxicity in patients with colorectal cancer (CRC). The modified Glasgow Prognostic Score (mGPS) is widely used to predict oncological outcomes, but its validity as a nutritional indicator for tolerance of systemic treatment remains debated. This study evaluated the predictive value of the mGPS as an inflammation-based nutritional assessment for systemic treatment tolerance in CRC patients.
Methods: Systemic treatment tolerance was compared between patients with low (0) versus high (1–2) mGPS scores. Systemic treatment tolerance was defined as: chemotoxicity and changes in predefined oncologic treatment protocol as a consequence of chemotoxicity. Severity of chemotoxicity was assessed by the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Univariate analyses were conducted to assess associations between chemotoxicity and potential predictive factors.
Results: A total of 101 outpatient CRC-patients who underwent neo-adjuvant or adjuvant/palliative chemotherapy (2020–2022) in the VieCuri Medical Centre were included. The median age of included patients was 67 years (range 20–90 years) and 62.4% were male. In total, 73.3% of patients were diagnosed with rectal cancer, 28.7% of patients had metastatic disease (51.9% in patients with colon cancer and 20.3% in patients with rectal cancer) and 40.6% received dual therapy. Patients with colon cancer, higher tumor stage, and who received dual (i.e. two types of chemotherapy) therapy were more frequently present in the higher mGPS group (1–2) compared to the lower mGPS group (0) (respectively 40.0% vs. 19.7%, 42.9% vs. 21.2%, and 60.0% vs. 30.3%). In univariate analysis, higher mGPS-scores were not associated with chemotoxicity (Odds Ratio (OR) 1.62 (Confidence Interval (CI) 0.53–4.93), P = 0.399).
Conclusions: Questions remain about the predictive value of the mGPS as inflammation-based nutritional assessment for systemic treatment tolerance in patients with CRC. This study showed that the mGPS was not significantly associated with systemic treatment tolerance. Since the mGPS seems to depend on tumor characteristics and treatment regimens, further large-scale studies with adequately powered subgroup analyses are needed to clarify its role as a nutritional assessment tool in CRC.