Abstract 1426P
Background
Despite the improvements in the therapeutic options and increasing significance of sequential strategies for advanced gastric cancer (AGC), the prognosis remains poor. Takahari et al previously reported that performance status (PS) ≥1, not receiving gastrectomy, the number of metastatic sites ≥2 and high serum ALP level are associated with poor prognosis and proposed a JCOG prognostic index by analyzing patients enrolled in clinical trials. However, the suitability assessment and utility of the JCOG prognostic index in real-world patients with AGC were unknown.
Methods
Patients with AGC who had been initiated platinum-containing chemotherapy as first-line treatment between January 2011 to December 2017 were retrospectively evaluated.
Results
Of 608 patients, the median overall survival (OS), progression-free survival (PFS), and post-progression survival (PPS) were 16.39 months, 7.18 months, and 7.28 months, respectively. In the multivariate analysis, PS ≥1 (Hazard ratio [HR], 1.557; 95% Confidence interval [CI], 1.295–1.871; p < 0.0001), no prior gastrectomy (HR, 1.307; 95%CI, 1.076–1.589; p = 0.007), high serum ALP level (HR, 1.272; 95%CI, 1.027–1.577; p = 0.0272), neutrophil-to-lymphocyte ratio (NLR) ≥4 (HR, 1.236; 95%CI, 1.016–1.504; p = 0.0337), and diffuse type (HR, 1.531; 95%CI, 1.295–1.849; p < 0.0001) were significantly associated with worse prognosis, whereas the number of metastases was not. Adapting the modified JCOG prognostic index which added diffuse type and NLR ≥4 into the JCOG prognostic index, median OS of the good (20.52 months), moderate (13.54 months; HR for death with good versus moderate, 1.69; 95%CI, 1.40–2.04; p < 0.0001), and poor (10.2 months; HR, 2.58; 95%CI, 1.89–3.52; p < 0.0001) risk groups demonstrated well-refined classification. The modified prognostic index also showed clear stratifications into three groups as of PPS.
Conclusions
The modified JCOG prognostic index showed favorable stratification of the OS and PPS in real-world patients. It might be helpful not only to predict prognosis but also to determine the timing of the treatment changes in the increasing importance of the sequential strategy in AGC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.