Prognostic value of the modified Glasgow Prognostic Score in patients with metastatic pancreatic cancer: An exploratory analysis of JCOG1611.

760 Background: The modified Glasgow Prognostic Score (mGPS), which combines serum levels of C-reactive protein and albumin, has been reported as a prognostic predictor in several malignancies. In this exploratory analysis of JCOG1611, a randomized phase II/III trial comparing gemcitabine plus nab-paclitaxel (GnP), modified 5-fluorouracil, levofolinate, irinotecan, and oxaliplatin (mFFX), and S-1, irinotecan, and oxaliplatin (S-IROX), we evaluated whether mGPS can predict prognosis of patients with metastatic pancreatic cancer. Methods: All patients eligible for JCOG1611 (n = 527) were included in this analysis. Patients were categorized into two groups according to their mGPS score: mGPS 0 and mGPS 1-2. The association between mGPS and overall survival (OS) was evaluated using multivariable Cox regression analysis. Results: The numbers of patients with mGPS 0 and mGPS 1-2 were 128 and 48 in the GnP arm, 129 and 46 in the mFFX arm, and 130 and 46 in the S-IROX arm, respectively. The median OS for mGPS 0 vs. 1-2 was 16.9 vs. 11.2, 14.3 vs. 9.5, and 14.7 vs. 10.6 months in the GnP, mFFX, and S-IROX arms, respectively. The adjusted hazard ratios (HRs) of OS were 1.359 (95% confidence interval CI:0.920–2.009) in the GnP arm, 1.289 (95% CI: 0.878–1.892) in the mFFX arm, and 1.612 (95% CI: 1.094–2.374) in the S-IROX arm, respectively. The median progression-free survival (PFS) for mGPS 0 vs. 1-2 was 7.0 vs. 5.6, 6.9 vs. 4.4, and 6.8 vs. 4.5 months in the GnP, mFFX, and S-IROX arms, respectively. The adjusted HRs of PFS were 1.160 (95% CI:0.812–1.657) in the GnP arm, 1.246 (95% CI: 0.866–1.793) in the mFFX arm, and 1.500 (95% CI: 1.033–2.177) in the S-IROX arm, respectively. Conclusions: mGPS showed a trend toward prognostic significance in patients with metastatic pancreatic cancer treated with GnP or mFFX, and suggested potential prognostic relevance in those treated with S-IROX.