title: Survival predictors for second-line chemotherapy in Caucasian patients with metastatic gastric cancer.
abstract: BACKGROUND
  There are very limited data suggesting a benefit for second-line chemotherapy in advanced gastric cancer. Therefore, the number of patients who receive further treatment after failure of first-line chemotherapy varies considerably, ranging from 14% to 75%. In the absence of a demonstrated survival benefit of second-line chemotherapy, appropriate selection of patients based on survival predictors is essential. However, no clinico-pathologic parameters are currently widely adopted in clinical practice. We looked exclusively at Caucasian patients with metastatic gastric cancer treated with second-line chemotherapy to see if we could establish prognostic factors for survival.
  
  
  METHODS
  This study retrospectively evaluated 43 Caucasian patients with metastatic gastric cancer treated with second-line chemotherapy at the Geneva University Hospital. Prognostic values of clinico-pathologic parameters were analysed by Cox regression for overall survival (OS).
  
  
  RESULTS
  Univariate analysis found three variables to be associated with survival: progression-free survival (PFS) at first-line chemotherapy of more than 26 weeks (hazard ratio (HR) = 0.33, confidence interval (CI) 95% 0.16-0.65, p = 0.002), previous curative surgery (HR = 0.51, CI 95% 0.27-0.96, p = 0.04) and carcinoma embryonic antigen (CEA) >6.5 μg/l (HR = 1.97, CI 95% 1.06-3.65, p = 0.03).
  
  
  CONCLUSIONS
  In line with published data, sensitivity to previous chemotherapy identifies Caucasian patients who will survive the longest following second-line chemotherapy. A low tumour burden and previous curative gastrectomy also seem to have a positive prognostic value.
authors.affiliation: Unit of Oncosurgery, University Hospital of Geneva, Switzerland. pbohanes@bluewin.ch
authors.forename: Pierre
authors.initials: P
authors.lastname: Bohanes
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Courvoisier
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Olivier
authors.initials: O
authors.lastname: Huber
authors.forename: Arnaud D
authors.initials: AD
authors.lastname: Roth
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D044465:White People
chemical_list: D002272:Carcinoembryonic Antigen