title: Prognostic significance of a systemic inflammatory response in patients receiving first-line palliative chemotherapy for recurred or metastatic gastric cancer.
abstract: BACKGROUND
  There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor prognosis in patients with advanced cancers. We evaluated the relationships between clinical status, laboratory factors and progression free survival (PFS), and overall survival (OS) in patients with recurrent or metastatic gastric cancer receiving first-line palliative chemotherapy.
  
  
  METHODS
  We reviewed 402 patients with advanced gastric adenocarcinoma who received first-line palliative chemotherapy from June 2004 and December 2009. Various chemotherapy regimens were used. Eastern Cooperative Oncology Group performance status (ECOG PS), C-reactive protein (CRP), albumin, Glasgow prognostic score (GPS), and clinical factors were recorded immediately prior to first-line chemotherapy. Patients with both an elevated CRP (>1.0 mg/dL) and hypoalbuminemia (<3.5 mg/dL) were assigned a GPS of 2. Patients in whom only one of these biochemical abnormalities was present were assigned a GPS of 1, and patients with a normal CRP and albumin were assigned a score of 0. To evaluate the factors that affected PFS and OS, univariate and multivariate analyses were performed.
  
  
  RESULTS
  According to multivariate analysis, the factors independently associated with PFS were ECOG PS (HR 1.37, 95% CI 1.02-1.84, P = 0.035), bone metastasis (HR 1.74, 95% CI 1.14-2.65, P = 0.009), and CRP elevation (HR 1.64, 95% CI 1.28-2.09, P = 0.001). The factors independently associated with OS were ECOG PS (HR 1.33, 95% CI 1.01-1.76, P = 0.037), bone metastasis (HR 1.61, 95% CI 1.08-2.39, P = 0.017), and GPS ≥ 1 (HR 1.76, 95% CI 1.41-2.19, P = 0.001).
  
  
  CONCLUSIONS
  The results of this study showed that the presence of a systemic inflammatory response as evidenced by the CRP, GPS was significantly associated with shorter PFS and OS in patients with recurrent or metastatic gastric cancer receiving first-line palliative chemotherapy. Bone metastasis and GPS were very useful indicator for survival in patients with recurrent or metastatic gastric cancer receiving palliative chemotherapy.
authors: Department of Internal Medicine, Division of Hemato-oncology, Chonnam National University Medical School, Gwangju, South Korea.
authors: Jun-Eul
authors: JE
authors: Hwang
authors: Ha-Na
authors: HN
authors: Kim
authors: Dae-Eun
authors: DE
authors: Kim
authors: Hyun-Jung
authors: HJ
authors: Choi
authors: Sung-Hoon
authors: SH
authors: Jung
authors: Hyun-Jeong
authors: HJ
authors: Shim
authors: Woo-Kyun
authors: WK
authors: Bae
authors: Eu-Chang
authors: EC
authors: Hwang
authors: Sang-Hee
authors: SH
authors: Cho
authors: Ik-Joo
authors: IJ
authors: Chung
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary; D002097:C-Reactive Protein / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010166:Palliative Care; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000378:metabolism; D055815:Young Adult
chemical_list: D000418:Albumins; D000970:Antineoplastic Agents; D002097:C-Reactive Protein