title: Neutropenia as a prognostic factor in advanced gastric cancer patients undergoing second-line chemotherapy with weekly paclitaxel.
abstract: BACKGROUND
  Neutropenia during chemotherapy has been reported to be a predictor of better survival in patients with several types of cancers, although there are no reports in pretreated patients.
  
  
  METHODS
  We retrospectively analyzed 242 patients with advanced gastric cancer (AGC) who received weekly paclitaxel (Taxol) as second-line chemotherapy. Background characteristics and neutropenia as time-varying covariates (TVCs) were analyzed as prognostic factors.
  
  
  RESULTS
  Of the 242 patients, mild neutropenia (grades 1-2) occurred in 101 patients (41.7%) and severe neutropenia (grades 3-4) occurred in 63 patients (26.0%). The other 78 patients (32.2%) did not experience neutropenia. According to a multivariate Cox model with neutropenia as a TVC, hazard ratios of death were 0.61 [95% confidence interval (CI) 0.43-0.85; P = 0.004] for patients with mild neutropenia and 0.61 (95% CI 0.41-0.88; P = 0.009) for those with severe neutropenia. Among the patients in landmark analysis (landmark of 2.5 months; median time to treatment failure of paclitaxel), mild and severe neutropenia remained significant prognostic factors.
  
  
  CONCLUSIONS
  Our results indicate that neutropenia during chemotherapy is associated with improved survival in patients with AGC who received weekly paclitaxel as second-line chemotherapy. Prospective trials are required to assess whether dosing adjustments based on neutropenia may improve chemotherapy efficacy.
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital. Electronic address: Kouheis0824@yahoo.co.jp.
authors.forename: K
authors.initials: K
authors.lastname: Shitara
authors.affiliation: Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute.
authors.forename: K
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital.
authors.forename: D
authors.initials: D
authors.lastname: Takahari
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Shibata
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Ura
authors.affiliation: Departments of Surgery.
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.affiliation: Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Sawaki
authors.affiliation: Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tajika
authors.affiliation: Departments of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital.
authors.forename: K
authors.initials: K
authors.lastname: Muro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D054316:Biomarkers, Pharmacological / Q000032:analysis / Q000097:blood; D002277:Carcinoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000175:diagnosis; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D054316:Biomarkers, Pharmacological; D017239:Paclitaxel