title: Clinical evidence for three distinct gastric cancer subtypes: time for a new approach.
abstract: BACKGROUND
  Recently, a new classification for gastric cancer (GC) has been proposed, based on Lauren's histology and on anatomic tumour location, identifying three subtypes of disease: type 1 (proximal non diffuse GC), type 2 (diffuse GC) and type 3 (distal non diffuse GC). Aim of our analysis was to compare clinical outcome according to different GC subtypes (1,2,3) in metastatic GC patients receiving first-line chemotherapy.
  
  
  METHODS
  Advanced GC pts treated with a first-line combination chemotherapy were included in our analysis. Pts were divided in three subgroups (type 1, type 2 and type 3) as previously defined.
  
  
  RESULTS
  A total of 248 advanced GC pts were included: 45.2% belonged to type 2, 43.6% to type 3 and 11.2% to type 1. Patients received a fluoropyrimidine-based chemotherapy doublet or three drugs regimens including a platinum derivate and a fluoropyrimidine with the addition of an anthracycline, a taxane or mytomicin C. RR was higher in type 1 pts (RR = 46.1%) and type 3 (34,3%) compared to type 2 (20,4%), (p = 0.015). Type 2 presented a shorter PFS, median PFS = 4.2 months, compared to type 1, mPFS = 7.2 months, and type 3, mPFS = 5.9 months (p = 0.011) and also a shorter OS (p = 0.022).
  
  
  CONCLUSIONS
  Our analysis suggests that GC subtypes may be important predictors of benefit from chemotherapy in advanced GC patients. Future clinical trials should take in account these differences for a better stratification of patients.
authors.affiliation: Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bittoni
authors.forename: Mario
authors.initials: M
authors.lastname: Scartozzi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giampieri
authors.forename: Luca
authors.initials: L
authors.lastname: Faloppi
authors.forename: Maristella
authors.initials: M
authors.lastname: Bianconi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mandolesi
authors.forename: Michela
authors.initials: M
authors.lastname: Del Prete
authors.forename: Mirco
authors.initials: M
authors.lastname: Pistelli
authors.forename: Luca
authors.initials: L
authors.lastname: Cecchini
authors.forename: Italo
authors.initials: I
authors.lastname: Bearzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010984:Platinum / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010984:Platinum