title: Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world.
abstract: BACKGROUND
  Although second-line therapy is often considered for advanced gastric cancer patients, the optimal candidates are not well defined.
  
  
  METHODS
  We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancer patients exposed to multiple treatment lines at 19 Italian centres. Cross-tables and chi-square tests were used to describe categorical features. To predict the impact of clinical variables on progression-free survival and overall survival, Kaplan-Meier and Cox regression analyses were performed.
  
  
  RESULTS
  At the start of second-line therapy, median age was 64.8 years (25th-75th percentiles: 55.2-71.9 years). Overall, 43% of patients received single-agent chemotherapy, 47.4% a doublet, and 7.3% a triplet. Median second-line progression-free survival was 2.8 months (25th-75th percentiles: 1.8-5.2 months) and median second-line overall survival was 5.6 months (25th-75th percentiles: 2.9-10.0 months). Multivariate analysis showed that performance status, LDH level, neutrophils/lymphocytes ratio, and progression-free survival in the first-line therapy all impacted on prognosis. Based on these four prognostic factors, a prognostic index was constructed that divided patients into good, intermediate, and poor risk groups; median second-line overall survival for each group was 7.7, 4.5, and 2.0 months, respectively (log-rank p < 0.0001).
  
  
  CONCLUSIONS
  Advanced gastric cancer patients with a favourable ECOG performance status, lower LDH levels, and a lower neutrophils/lymphocytes ratio at the start of second-line therapy seem to have better outcomes, regardless of age and intensity of treatment. A longer progression-free survival in the first-line therapy also had positive prognostic value. Our real-life study might help clinicians to identify the patients who may benefit most from a second-line therapy.
authors.affiliation: Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Fanotto
authors.affiliation: Department of Oncology, Garibaldi Nesima Hospital, Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cordio
authors.affiliation: UO Oncologia Medica 2 Universitaria, Ospedale S. Chiara-Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pasquini
authors.affiliation: Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Fontanella
authors.affiliation: Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Rimassa
authors.affiliation: Institute for Cancer Research and Treatment IRCCS, Candiolo, TO, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Leone
authors.affiliation: Medical Oncology, San Carlo Hospital, Potenza, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rosati
authors.affiliation: Medical Oncology, Campus Bio-Medico University, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: Medical Oncology, Ospedali Riuniti, Ancona, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giampieri
authors.affiliation: Department of Medical Oncology, General Hospital, Prato, Italy.
authors.forename: Samantha
authors.initials: S
authors.lastname: Di Donato
authors.affiliation: Medical Oncology Division, Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Tomasello
authors.affiliation: Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
authors.affiliation: Medical Oncology, National Cancer Institute IRCCS, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Pietrantonio
authors.affiliation: UOC Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Istituto Oncologico Veneto-IRCCS, Padua, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Battaglin
authors.affiliation: Gastrointestinal Oncology, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Avallone
authors.affiliation: Medical Oncology, University Hospital, University of Cagliari, Cagliari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Scartozzi
authors.affiliation: Medical Oncology, Perrino Hospital, Brindisi, Italy.
authors.forename: Eufemia Stefania
authors.initials: ES
authors.lastname: Lutrino
authors.affiliation: Medical Oncology, University of Verona, Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Melisi
authors.affiliation: Medical Oncology, Careggi University Hospital, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Antonuzzo
authors.affiliation: Medical Oncology, Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellegrino
authors.affiliation: Oncology Unit, IRCCS Mario Negri Institute, Milan, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.affiliation: Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy. giuseppe.aprile@asuiud.sanita.fvg.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Advanced gastric cancer; Overall survival; Prognostic factors; Progression-free survival; Second-line chemotherapy