![]() It is difficult to predict the prognosis of patients with RCC because of its heterogeneous biological nature. Besides, we also did not detect the publication bias, which indicates the reliability of our study. We also performed sensitivity analyses, and the trend of adjusted results did not alter. Although heterogeneity existed after subgroup analyses, it decreased in several subgroups. As for patients of different regions, the pooled results are consistent with previous results. In patients with different stages of RCC, there was also a significant association between mGPS and survival. In different cutoff values, the mGPS also could be considered as a predictive factor for survival. We found that higher mGPS results in poorer OS and CSS in patients with clear cell RCC and other RCC. ![]() Since there was obvious heterogeneity among studies, we carried out subgroup analyses based on pathological type, the cutoff value of mGPS, stage, and regions. The pooled results suggested that higher mGPS was significantly linked with decreased OS and CSS and increased risk of recurrence and progression. Our studies pooled all eligible studies to evaluate the association between mGPS and survival in patients with RCC. Detailed results of subgroup analyses are summarized in Table 2. Besides, heterogeneity was reduced in several subgroups. The subgroup analyses based on regions show that both Asian and Western patients with higher mGPS had a decline of OS and CSS. For advanced/metastatic or all stages of RCC, there was also a significant association between mGPS and survival. In patients with localized RCC, increased mGPS was correlated to inferior OS (HR=3.93 95%CI, 2.13–7.27) and CSS (HR=3.91 95%CI, 1.94–7.86). Studies which used 1 and 2 as the cutoff values revealed that mGPS could serve as a prognostic factor for OS. In other pathological types, higher mGPS are also associated with lower OS and CSS. As shown in Table 2, we demonstrated that higher mGPS had a poorer OS (HR=3.54 95%CI, 2.48–5.06) and CSS (HR=5.99 95%CI, 3.94–9.09) in patients with clear cell RCC. While because of the small number of enrolled studies, we only conducted subgroup analyses for CSS based on pathology, stage, and regions. ![]() In the present study, we evaluated the association between pretreatment mGPS and prognosis by searching available literature and pooling all outcome data.Ġ: 38 (32.3%) 1: 17 (14.4%) 2: 62 (53.3%)Ġ: 92 (50.8%) 1: 36 (19.9%) 2: 53 (29.3%)Ġ: 267 (75.8%) 1: 38 (10.8%) 2: 47 (13.3%)Ġ: 80 (62.0%) 1: 27 (20.9%) 2: 22 (17.1%)ĭue to obvious heterogeneity among studies, we accomplished subgroup analyses for OS stratified by pathological type, the cutoff value of mGPS, stage, and regions. Therefore, it is necessary to evaluate the prognostic value of mGPS for patients with RCC by conducting a systematic review and meta-analysis. 13, 16 – 18 However, the prognostic value of mGPS for RCC remains unclear, and the findings of different studies are inconsistent. 12 – 15 Modifying GPS as modified Glasgow prognostic score (mGPS), giving a score of 1 only for an elevated CRP, has been considered as a prognostic factor for several cancers such as non-small cell lung cancer, esophageal cancer, hepatocellular carcinoma, as well as RCC. This score has been shown to have prognosis value for various tumors including gastric cancer, non-small cell lung cancer, esophageal cancer, as well as RCC. 10, 11 Glasgow prognostic score (GPS), a combination of CRP and albumin levels, reflects systemic inflammation and nutritional status. 8, 9 Reportedly, an increasing number demonstrated that inflammation biomarkers, such as C-reactive protein (CRP), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) could predict prognosis of RCC. 6, 7 Currently, more evidence suggested that systemic inflammation is associated with disease development and progression. ![]() 5 TNM stage and Fuhrman nuclear grade are widely served as prognostic factors, but these factors have limited accuracy. Stratifications of patients based on the risk of recurrence are important to aid decision-making, to identify further follow-up and to judge whether patients should be enrolled in adjuvant clinical trials. 3 Treatments for metastatic RCC also have developed rapidly, including cytoreductive nephrectomy, immunotherapy, or target therapy, but the clinical outcome is not encouraging. 2 Although the development of treatment for localized RCC, such as radical nephrectomy or partial nephrectomy, approximately 20–40% of patients will have local or distal recurrence. Approximately 67% of newly diagnosed patients are localized disease, 16% of patients present regional or distant metastases. 1 The occurrence of RCC has been increasing over the past three decades. Renal cell carcinoma (RCC) accounts for 2–3% of all cancers, with an estimated 403,262 new cases in the world in 2018. ![]()
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