World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 11, Number 3, June 2020, pages 98-105

Gustave Roussy Immune Score and Royal Marsden Hospital Prognostic Score Are Prognostic Markers for Extensive Disease of Small Cell Lung Cancer

Figure 1. Kaplan-Meier curves of overall survival according to GRIm-score (a) and RMH score (b). GRIm-score: Gustave Roussy immune score; RMH score: Royal Marsden Hospital prognostic score.

Figure 2. Kaplan-Meier curves of progression-free survival according to GRIm-score (a) and RMH score (b). GRIm-score: Gustave Roussy immune score; RMH score: Royal Marsden Hospital prognostic score.

**Table 1.** Distribution of GRIm-Score and RMH Score
GRIm-score	RMH score
GRIm-score: Gustave Roussy immune score; RMH score: Royal Marsden Hospital prognostic score.
0	17	6	0	0	23
1	0	30	26	0	56
2	0	0	22	15	37
3	0	0	4	8	12
Total	17	36	52	23	128

Table 1. Distribution of GRIm-Score and RMH Score

GRIm-score

RMH score

Total

GRIm-score: Gustave Roussy immune score; RMH score: Royal Marsden Hospital prognostic score.

Total

128

**Table 2.** Baseline Characteristics, Treatment and Laboratory Data According to GRIm-Score
	GRIm-score	P
^aFisher exact test. ^bMann-Whitney U test. BMI: body mass index; CI: confidence interval; CR: complete response; CS: current smoker; DCR: disease control rate; ECOG-PS: Eastern Cooperative Oncology Group performance status; Ex: ex-smoker; GRIm-score: Gustave Roussy immune score; IQR: interquartile range; LDH: lactate dehydrogenase; NE: not evaluated; NLR: neutrophil-to-lymphocyte ratio; NS: non-smoker; ORR: overall response rate; PD: progressive disease; SD: stable disease; ULN: upper limit of normal.
N	79	49
Backgrounds
Sex (N)
Male/female	65/14	36/13	0.27^a
Age (years)
Median (IQR)	71 (64 - 76)	72 (66 - 81)	0.17^b
< 75/≥ 75 years	49/30	30/19	1.00^a
Smoking status (N)
NS/Ex/CS/unknown	1/24/53/1	2/17/30/0	0.69^a
BMI
Median (IQR)	23.1 (20.3 - 26.2)	21.1 (19.0 - 23.8)	< 0.01^b
≥ 18.5/< 18.5 (N)	72/7	40/9	0.17^a
ECOG-PS (N)
0 - 1/2/3	57/18/4	20/13/16	< 0.01^a
Metastatic sites (N)
< 3/≥ 3	46/33	19/33	0.045^a
Treatment
Regimen (N)
Platinum-based
Cisplatin/carboplatin	20/59	11/38	0.83^a
Partner drugs
Etoposide/irinotecan	67/12	46/3	0.16^a
Efficacy
CR/PR/SD/PD/NE	2/51/11/11/4	0/25/6/10/8	0.14^a
ORR (%) (95% CI)	67.1 (55.6 - 77.3)	51.0 (36.3 - 65.6)	0.09^a
DCR (%) (95% CI)	81.0 (70.6 - 89.0)	63.3 (48.3 - 76.6)	0.04^a
Second or later line (N)	51	18	< 0.01^a
Amrubicin (N)	38	11	< 0.01^a
Topotecan (N)	10	3	0.37^a
Irinotecan (N)	6	1	0.25^a
Radiotherapy
Brain	22	6	0.048^a
Thoracic	6	4	1.00^a
Laboratory data
NLR
Median (IQR)	2.7 (2.0 - 4.1)	4.7 (3.3 - 8.7)	< 0.01^b
> 6 (N)	1	20	< 0.01^a
LDH (U/L)
Median (IQR)	233 (196.5 - 350)	398 (280 - 493)	< 0.01^b
> ULN (N)	43	48	< 0.01^a
Albumin (g/dL)
Median (IQR)	3.9 (3.6 - 4.1)	3.1 (2.7 - 3.4)	< 0.01^b
< 3.5 g/dL (N)	12	42	< 0.01^a

Table 2. Baseline Characteristics, Treatment and Laboratory Data According to GRIm-Score

GRIm-score

Low

High

^aFisher exact test. ^bMann-Whitney U test. BMI: body mass index; CI: confidence interval; CR: complete response; CS: current smoker; DCR: disease control rate; ECOG-PS: Eastern Cooperative Oncology Group performance status; Ex: ex-smoker; GRIm-score: Gustave Roussy immune score; IQR: interquartile range; LDH: lactate dehydrogenase; NE: not evaluated; NLR: neutrophil-to-lymphocyte ratio; NS: non-smoker; ORR: overall response rate; PD: progressive disease; SD: stable disease; ULN: upper limit of normal.

Backgrounds

Sex (N)

Male/female

65/14

36/13

0.27^a

Age (years)

Median (IQR)

71 (64 - 76)

72 (66 - 81)

0.17^b

< 75/≥ 75 years

49/30

30/19

1.00^a

Smoking status (N)

NS/Ex/CS/unknown

1/24/53/1

2/17/30/0

0.69^a

BMI

Median (IQR)

23.1 (20.3 - 26.2)

21.1 (19.0 - 23.8)

< 0.01^b

≥ 18.5/< 18.5 (N)

72/7

40/9

0.17^a

ECOG-PS (N)

0 - 1/2/3

57/18/4

20/13/16

< 0.01^a

Metastatic sites (N)

< 3/≥ 3

46/33

19/33

0.045^a

Treatment

Regimen (N)

Platinum-based

Cisplatin/carboplatin

20/59

11/38

0.83^a

Partner drugs

Etoposide/irinotecan

67/12

46/3

0.16^a

Efficacy

CR/PR/SD/PD/NE

2/51/11/11/4

0/25/6/10/8

0.14^a

ORR (%) (95% CI)

67.1 (55.6 - 77.3)

51.0 (36.3 - 65.6)

0.09^a

DCR (%) (95% CI)

81.0 (70.6 - 89.0)

63.3 (48.3 - 76.6)

0.04^a

Second or later line (N)

< 0.01^a

Amrubicin (N)

< 0.01^a

Topotecan (N)

0.37^a

Irinotecan (N)

0.25^a

Radiotherapy

Brain

0.048^a

Thoracic

1.00^a

Laboratory data

NLR

Median (IQR)

2.7 (2.0 - 4.1)

4.7 (3.3 - 8.7)

< 0.01^b

> 6 (N)

< 0.01^a

LDH (U/L)

Median (IQR)

233 (196.5 - 350)

398 (280 - 493)

< 0.01^b

> ULN (N)

< 0.01^a

Albumin (g/dL)

Median (IQR)

3.9 (3.6 - 4.1)

3.1 (2.7 - 3.4)

< 0.01^b

< 3.5 g/dL (N)

< 0.01^a

**Table 3.** Baseline Characteristics, Treatment and Laboratory Data According to RMH Score
	RMH score	P
^aFisher exact test. ^bMann-Whitney U test. BMI: body mass index; CI: confidence interval; CR: complete response; CS: current smoker; DCR: disease control rate; ECOG-PS: Eastern Cooperative Oncology Group performance status; Ex: ex-smoker; IQR: interquartile range; LDH: lactate dehydrogenase; NE: not evaluated; NLR: neutrophil-to-lymphocyte ratio; NS: non-smoker; ORR: overall response rate; PD: progressive disease; RMH score: Royal Marsden Hospital prognostic score; SD: stable disease; ULN: upper limit of normal.
N	54	74
Backgrounds
Sex (N)
Male/female	45/9	56/18	0.38^a
Age (years)
Median (IQR)	72 (66 - 76)	71.5 (65.3 - 80)	0.83^b
< 75/≥ 75 years	33/21	46/28	1.00^a
Smoking status (N)
NS/Ex/CS/unknown	1/19/34/0	2/22/49/1	0.93^a
BMI
Median (IQR)	22.8 (19.8 - 26.1)	21.3 (19.4 - 24.3)	0.22^b
≥ 18.5/< 18.5 (N)	49/5	63/11	0.42^a
ECOG-PS (N)
0 - 1/2/3	39/13/2	38/18/18	< 0.01^a
Metastatic sites (N)
< 3/≥ 3	47/7	18/56	< 0.01^a
Treatment
Regimen (N)
Platinum-based
Cisplatin/carboplatin	12/42	19/55	0.68^a
Partner drugs
Etoposide/irinotecan	46/8	67/7	0.41^a
Efficacy
CR/PR/SD/PD/NE	1/35/10/7/1	1/41/7/14/11	0.04^a
ORR (%) (95% CI)	66.7 (52.5 - 78.9)	56.8 (44.7 - 68.2)	0.27^a
DCR (%) (95% CI)	85.2 (72.9 - 93.4)	66.2 (54.3 - 76.8)	0.02^a
Second or later line (N)	39	30	< 0.01^a
Amrubicin (N)	28	21	< 0.01^a
Topotecan (N)	4	9	0.56^a
Irinotecan (N)	4	3	0.45^a
Radiotherapy
Brain	15	13	0.20^a
Thoracic	5	5	0.74^a
Laboratory data
NLR
Median (IQR)	2.6 (2.0 - 4.0)	4.1 (2.7 - 5.8)	< 0.01^b
> 6 (N)	2	19	< 0.01^a
LDH (U/L)
Median (IQR)	212 (186 - 314)	332 (266 - 490)	< 0.01^b
> ULN (N)	23	68	< 0.01^a
Albumin (g/dL)
Median (IQR)	3.9 (3.7 - 4.1)	3.3 (2.8 - 3.8)	<0.01^b
< 3.5 g/dL (N)	7	47	<0.01^a

Table 3. Baseline Characteristics, Treatment and Laboratory Data According to RMH Score

RMH score

Low

High

^aFisher exact test. ^bMann-Whitney U test. BMI: body mass index; CI: confidence interval; CR: complete response; CS: current smoker; DCR: disease control rate; ECOG-PS: Eastern Cooperative Oncology Group performance status; Ex: ex-smoker; IQR: interquartile range; LDH: lactate dehydrogenase; NE: not evaluated; NLR: neutrophil-to-lymphocyte ratio; NS: non-smoker; ORR: overall response rate; PD: progressive disease; RMH score: Royal Marsden Hospital prognostic score; SD: stable disease; ULN: upper limit of normal.

Backgrounds

Sex (N)

Male/female

45/9

56/18

0.38^a

Age (years)

Median (IQR)

72 (66 - 76)

71.5 (65.3 - 80)

0.83^b

< 75/≥ 75 years

33/21

46/28

1.00^a

Smoking status (N)

NS/Ex/CS/unknown

1/19/34/0

2/22/49/1

0.93^a

BMI

Median (IQR)

22.8 (19.8 - 26.1)

21.3 (19.4 - 24.3)

0.22^b

≥ 18.5/< 18.5 (N)

49/5

63/11

0.42^a

ECOG-PS (N)

0 - 1/2/3

39/13/2

38/18/18

< 0.01^a

Metastatic sites (N)

< 3/≥ 3

47/7

18/56

< 0.01^a

Treatment

Regimen (N)

Platinum-based

Cisplatin/carboplatin

12/42

19/55

0.68^a

Partner drugs

Etoposide/irinotecan

46/8

67/7

0.41^a

Efficacy

CR/PR/SD/PD/NE

1/35/10/7/1

1/41/7/14/11

0.04^a

ORR (%) (95% CI)

66.7 (52.5 - 78.9)

56.8 (44.7 - 68.2)

0.27^a

DCR (%) (95% CI)

85.2 (72.9 - 93.4)

66.2 (54.3 - 76.8)

0.02^a

Second or later line (N)

< 0.01^a

Amrubicin (N)

< 0.01^a

Topotecan (N)

0.56^a

Irinotecan (N)

0.45^a

Radiotherapy

Brain

0.20^a

Thoracic

0.74^a

Laboratory data

NLR

Median (IQR)

2.6 (2.0 - 4.0)

4.1 (2.7 - 5.8)

< 0.01^b

> 6 (N)

< 0.01^a

LDH (U/L)

Median (IQR)

212 (186 - 314)

332 (266 - 490)

< 0.01^b

> ULN (N)

< 0.01^a

Albumin (g/dL)

Median (IQR)

3.9 (3.7 - 4.1)

3.3 (2.8 - 3.8)

<0.01^b

< 3.5 g/dL (N)

<0.01^a

**Table 4.** Multivariate Cox Hazard Proportional Analyses of Overall Survival of All Patients
Variable	GRIm-score	RMH score
BMI: body mass index; CI: confidence interval; ECOG-PS: Eastern Cooperative Oncology Group performance status; GRIm-score: Gustave Roussy immune score; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; RMH score: Royal Marsden Hospital prognostic score.
Age (years)
< 75	1 (Reference)		1 (Reference)
≥ 75	1.34 (0.87 - 2.06)	0.19	1.29 (0.82 - 2.02)	0.27
BMI
≥ 18.5	1 (Reference)		1 (Reference)
< 18.5	1.39 (0.79 - 2.45)	0.25	1.57 (0.89 - 2.77)	0.12
Platinum-based
Cisplatin	1 (Reference)		1 (Reference)
Carboplatin	0.94 (0.54 - 1.62)	0.82	0.82 (0.48 - 1.41)	0.48
ECOG-PS
0 - 1	1 (Reference)		1 (Reference)
2 - 4	2.16 (1.41 - 3.31)	< 0.01	2.12 (1.38 - 3.24)	< 0.01
No. of metastases
< 3	1 (Reference)
≥ 3	1.97 (1.29 - 3.02)	< 0.01
GRIm-score
Low (0 - 1)	1 (Reference)
High (2 - 3)	1.80 (1.20 - 2.72)	< 0.01
NLR
< 6			1 (Reference)
≥ 6			1.17 (0.65 - 2.09)	0.60
RMH score
Low (0 - 1)			1 (Reference)
High (2 - 3)			1.93 (1.27 - 2.92)	< 0.01

Table 4. Multivariate Cox Hazard Proportional Analyses of Overall Survival of All Patients

Variable

GRIm-score

RMH score

HR (95% CI)

BMI: body mass index; CI: confidence interval; ECOG-PS: Eastern Cooperative Oncology Group performance status; GRIm-score: Gustave Roussy immune score; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; RMH score: Royal Marsden Hospital prognostic score.

Age (years)

< 75

1 (Reference)

≥ 75

1.34 (0.87 - 2.06)

0.19

1.29 (0.82 - 2.02)

0.27

BMI

≥ 18.5

1 (Reference)

< 18.5

1.39 (0.79 - 2.45)

0.25

1.57 (0.89 - 2.77)

0.12

Platinum-based

Cisplatin

1 (Reference)

Carboplatin

0.94 (0.54 - 1.62)

0.82

0.82 (0.48 - 1.41)

0.48

ECOG-PS

0 - 1

1 (Reference)

2 - 4

2.16 (1.41 - 3.31)

< 0.01

2.12 (1.38 - 3.24)

< 0.01

No. of metastases

< 3

1 (Reference)

≥ 3

1.97 (1.29 - 3.02)

< 0.01

GRIm-score

Low (0 - 1)

1 (Reference)

High (2 - 3)

1.80 (1.20 - 2.72)

< 0.01

NLR

< 6

1 (Reference)

≥ 6

1.17 (0.65 - 2.09)

0.60

RMH score

Low (0 - 1)

1 (Reference)

High (2 - 3)

1.93 (1.27 - 2.92)

< 0.01

**Table 5.** Multivariate Cox Hazard Proportional Analyses of Progression-Free Survival of First-Line Chemotherapy
Variables	GRIm-score	RMH score
BMI: body mass index; CI: confidence interval; ECOG-PS: Eastern Cooperative Oncology Group performance status; GRIm-score: Gustave Roussy immune score; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; RMH score: Royal Marsden Hospital prognostic score.
Age (years)
< 75	1 (Reference)		1 (Reference)
≥ 75	0.98 (0.65 - 1.47)	0.91	1.00 (0.66 - 1.51)	1.00
BMI
≥ 18.5	1 (Reference)		1 (Reference)
< 18.5	1.30 (0.76 - 2.22)	0.34	1.21 (0.71 - 2.06)	0.49
Platinum-based
Cisplatin	1 (Reference)		1 (Reference)
Carboplatin	1.22 (0.73 - 2.01)	0.45	1.08 (0.66 - 1.78)	0.76
ECOG-PS
0 - 1	1 (Reference)		1 (Reference)
2 - 4	1.27 (0.84 - 1.92)	0.26	1.33 (0.88 - 2.02)	0.18
No. of metastases
< 3	1 (Reference)
≥ 3	1.60 (1.09 - 2.34)	0.02
GRIm-Score
Low (0 - 1)	1 (Reference)
High (2 - 3)	1.13 (0.76 - 1.67)	0.55
NLR
< 6			1 (Reference)
≥ 6			0.87 (0.49 - 1.55)	0.65
RMH score
Low (0 - 1)			1 (Reference)
High (2 - 3)			1.53 (1.04 - 2.25)	0.03

Table 5. Multivariate Cox Hazard Proportional Analyses of Progression-Free Survival of First-Line Chemotherapy

Variables

GRIm-score

RMH score

HR (95% CI)

Age (years)

< 75

1 (Reference)

≥ 75

0.98 (0.65 - 1.47)

0.91

1.00 (0.66 - 1.51)

1.00

BMI

≥ 18.5

1 (Reference)

< 18.5

1.30 (0.76 - 2.22)

0.34

1.21 (0.71 - 2.06)

0.49

Platinum-based

Cisplatin

1 (Reference)

Carboplatin

1.22 (0.73 - 2.01)

0.45

1.08 (0.66 - 1.78)

0.76

ECOG-PS

0 - 1

1 (Reference)

2 - 4

1.27 (0.84 - 1.92)

0.26

1.33 (0.88 - 2.02)

0.18

No. of metastases

< 3

1 (Reference)

≥ 3

1.60 (1.09 - 2.34)

0.02

GRIm-Score

Low (0 - 1)

1 (Reference)

High (2 - 3)

1.13 (0.76 - 1.67)

0.55

NLR

< 6

1 (Reference)

≥ 6

0.87 (0.49 - 1.55)

0.65

RMH score

Low (0 - 1)

1 (Reference)

High (2 - 3)

1.53 (1.04 - 2.25)

0.03