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.

Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world / Fanotto V.; Cordio S.; Pasquini G.; Fontanella C.; Rimassa L.; Leone F.; Rosati G.; Santini D.; Giampieri R.; Di Donato S.; Tomasello G.; Silvestris N.; Pietrantonio F.; Battaglin F.; Avallone A.; Scartozzi M.; Lutrino E.S.; Melisi D.; Antonuzzo L.; Pellegrino A.; Torri V.; Aprile G.. - In: GASTRIC CANCER. - ISSN 1436-3291. - ELETTRONICO. - 20:(2017), pp. 825-833. [10.1007/s10120-016-0681-6]

Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world

Di Donato S.;Tomasello G.;Antonuzzo L.
Membro del Collaboration Group
;
Torri V.;Aprile G.
2017

Abstract

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.
2017
20
825
833
Fanotto V.; Cordio S.; Pasquini G.; Fontanella C.; Rimassa L.; Leone F.; Rosati G.; Santini D.; Giampieri R.; Di Donato S.; Tomasello G.; Silvestris N.; Pietrantonio F.; Battaglin F.; Avallone A.; Scartozzi M.; Lutrino E.S.; Melisi D.; Antonuzzo L.; Pellegrino A.; Torri V.; Aprile G.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1193610
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