Valentina Fanotto1, Stefano Cordio2, Giulia Pasquini3, Caterina Fontanella1, Lorenza Rimassa4, Francesco Leone5, Gerardo Rosati6, Daniele Santini7, Riccardo Giampieri8, Samantha Di Donato9, Gianluca Tomasello10, Nicola Silvestris11, Filippo Pietrantonio12, Francesca Battaglin13, Antonio Avallone14, Mario Scartozzi15, Eufemia Stefania Lutrino16, Davide Melisi17, Lorenzo Antonuzzo18, Antonio Pellegrino19, Valter Torri20, Giuseppe Aprile21. 1. Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy. 2. Department of Oncology, Garibaldi Nesima Hospital, Catania, Italy. 3. UO Oncologia Medica 2 Universitaria, Ospedale S. Chiara-Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy. 4. Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, MI, Italy. 5. Institute for Cancer Research and Treatment IRCCS, Candiolo, TO, Italy. 6. Medical Oncology, San Carlo Hospital, Potenza, Italy. 7. Medical Oncology, Campus Bio-Medico University, Rome, Italy. 8. Medical Oncology, Ospedali Riuniti, Ancona, Italy. 9. Department of Medical Oncology, General Hospital, Prato, Italy. 10. Medical Oncology Division, Istituti Ospitalieri di Cremona, Cremona, Italy. 11. Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy. 12. Medical Oncology, National Cancer Institute IRCCS, Milan, Italy. 13. UOC Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Istituto Oncologico Veneto-IRCCS, Padua, Italy. 14. Gastrointestinal Oncology, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy. 15. Medical Oncology, University Hospital, University of Cagliari, Cagliari, Italy. 16. Medical Oncology, Perrino Hospital, Brindisi, Italy. 17. Medical Oncology, University of Verona, Verona, Italy. 18. Medical Oncology, Careggi University Hospital, Florence, Italy. 19. Medical Oncology, Vito Fazzi Hospital, Lecce, Italy. 20. Oncology Unit, IRCCS Mario Negri Institute, Milan, Italy. 21. Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy. giuseppe.aprile@asuiud.sanita.fvg.it.
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.
BACKGROUND: Although second-line therapy is often considered for advanced gastric cancerpatients, the optimal candidates are not well defined. METHODS: We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancerpatients 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 cancerpatients 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.
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