TY - JOUR
T1 - Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world
AU - Fanotto, Valentina
AU - Cordio, Stefano
AU - Pasquini, Giulia
AU - Fontanella, Caterina
AU - Rimassa, Lorenza
AU - Leone, Francesco
AU - Rosati, Gerardo
AU - Santini, Daniele
AU - Giampieri, Riccardo
AU - Di Donato, Samantha
AU - Tomasello, Gianluca
AU - Silvestris, Nicola
AU - Pietrantonio, Filippo
AU - Battaglin, Francesca
AU - Avallone, Antonio
AU - Scartozzi, Mario
AU - Lutrino, Eufemia Stefania
AU - Melisi, Davide
AU - Antonuzzo, Lorenzo
AU - Pellegrino, Antonio
AU - Torri, Valter
AU - Aprile, Giuseppe
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: Although second-line therapy is often considered for advanced gastric cancer patients, the optimal candidates are not well defined. Methods: We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancer patients exposed to multiple treatment lines at 19 Italian centres. Cross-tables and chi-square tests were used to describe categorical features. To predict the impact of clinical variables on progression-free survival and overall survival, Kaplan–Meier and Cox regression analyses were performed. Results: At the start of second-line therapy, median age was 64.8 years (25th–75th percentiles: 55.2–71.9 years). Overall, 43% of patients received single-agent chemotherapy, 47.4% a doublet, and 7.3% a triplet. Median second-line progression-free survival was 2.8 months (25th–75th percentiles: 1.8–5.2 months) and median second-line overall survival was 5.6 months (25th–75th percentiles: 2.9–10.0 months). Multivariate analysis showed that performance status, LDH level, neutrophils/lymphocytes ratio, and progression-free survival in the first-line therapy all impacted on prognosis. Based on these four prognostic factors, a prognostic index was constructed that divided patients into good, intermediate, and poor risk groups; median second-line overall survival for each group was 7.7, 4.5, and 2.0 months, respectively (log-rank p < 0.0001). Conclusions: Advanced gastric cancer patients with a favourable ECOG performance status, lower LDH levels, and a lower neutrophils/lymphocytes ratio at the start of second-line therapy seem to have better outcomes, regardless of age and intensity of treatment. A longer progression-free survival in the first-line therapy also had positive prognostic value. Our real-life study might help clinicians to identify the patients who may benefit most from a second-line therapy.
AB - Background: Although second-line therapy is often considered for advanced gastric cancer patients, the optimal candidates are not well defined. Methods: We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancer patients exposed to multiple treatment lines at 19 Italian centres. Cross-tables and chi-square tests were used to describe categorical features. To predict the impact of clinical variables on progression-free survival and overall survival, Kaplan–Meier and Cox regression analyses were performed. Results: At the start of second-line therapy, median age was 64.8 years (25th–75th percentiles: 55.2–71.9 years). Overall, 43% of patients received single-agent chemotherapy, 47.4% a doublet, and 7.3% a triplet. Median second-line progression-free survival was 2.8 months (25th–75th percentiles: 1.8–5.2 months) and median second-line overall survival was 5.6 months (25th–75th percentiles: 2.9–10.0 months). Multivariate analysis showed that performance status, LDH level, neutrophils/lymphocytes ratio, and progression-free survival in the first-line therapy all impacted on prognosis. Based on these four prognostic factors, a prognostic index was constructed that divided patients into good, intermediate, and poor risk groups; median second-line overall survival for each group was 7.7, 4.5, and 2.0 months, respectively (log-rank p < 0.0001). Conclusions: Advanced gastric cancer patients with a favourable ECOG performance status, lower LDH levels, and a lower neutrophils/lymphocytes ratio at the start of second-line therapy seem to have better outcomes, regardless of age and intensity of treatment. A longer progression-free survival in the first-line therapy also had positive prognostic value. Our real-life study might help clinicians to identify the patients who may benefit most from a second-line therapy.
KW - Advanced gastric cancer
KW - Overall survival
KW - Prognostic factors
KW - Progression-free survival
KW - Second-line chemotherapy
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U2 - 10.1007/s10120-016-0681-6
DO - 10.1007/s10120-016-0681-6
M3 - Article
AN - SCOPUS:85007425804
VL - 20
SP - 825
EP - 833
JO - Gastric Cancer
JF - Gastric Cancer
SN - 1436-3291
IS - 5
ER -