Progression-free survival in first-line chemotherapy is a prognostic factor in second-line chemotherapy in patients with advanced gastric cancer.
OBJECTIVE
First-line chemotherapy (Cx-1) in advanced gastric cancer (AGC) provides survival benefit. However, it is unclear who should proceed to second-line chemotherapy (Cx-2).


METHODS
We reviewed patients who received Cx-2 for AGC following progressive disease after Cx-1 from 2000 to 2005 at the National Cancer Center Hospital, Tokyo. To evaluate the prognostic factors in Cx-2, Cox regression multivariate analysis was performed.


RESULTS
Of 995 patients who received Cx-1 in this study period, 466 met the eligibility criteria. The median progression-free survival in Cx-1 (PFS-1) was 133 days. The median survival time from the date of starting second-line chemotherapy (MST-2) was 207 days. Multivariate analysis revealed that the factors affecting short survival time in Cx-2 were poor performance status (> or = 2), low serum albumin level (<3.5 mg/dL), elevated C-reactive protein level (> or = 1.0 mg/dL), patients with bone, liver or peritoneal metastasis, and patients without previous gastrectomy (p < 0.01). PFS-1 was an independent prognostic factor for survival (PFS-1 <120, MST-2 133 days, PFS-1 > or = 120, MST-2 258 days, hazard ratio 0.71, 95% confidence interval 0.58-0.86, p < 0.01). The Cx-2 regimen (irinotecan vs. taxane) did not correlate with survival.


CONCLUSIONS
PFS-1 is one of the prognostic factors of Cx-2 in patients with AGC.
Hashimoto
Kenji
K
Gastrointestinal Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuuou-ku Tokyo 104-0045, Japan.
Takashima
Atsuo
A
Nagashima
Kengo
K
Okazaki
Shun-suke
SS
Nakajima
Takako Eguchi
TE
Kato
Ken
K
Hamaguchi
Tetsuya
T
Yamada
Yasuhide
Y
Shimada
Yasuhiro
Y
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult