Prognostic factor analysis of third-line chemotherapy in patients with advanced gastric cancer

Abstract

Background Almost all patients with advanced gastric cancer will eventually develop progressive disease after first-line chemotherapy. However, the role of subsequent salvage chemotherapy remains controversial. The purpose of this study was to evaluate prognostic factors for the survival of patients with advanced gastric cancer who received third-line chemotherapy. Methods We reviewed 502 patients with advanced gastric cancer who received palliative chemotherapy at the Ono-cology Department of Hwasun Chonnam National University Hospital (2004-2008). Among them, 174 received third-line chemotherapy. To evaluate the clinicopathologic factors that affected overall survival, univariate and mul-tivariate analyses were performed on the baseline factors before beginning third-line chemotherapy. Results Multivariate analysis found 4 prognostic factors affecting poor survival following third-line chemotherapy: performance status of 2-3 (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.06-2.02; P = 0.022), serum albumin level < 4 mg/dL (HR 1.82, 95% CI 1.32-2.53; P < 0.00), poor histologic type (HR 1.77, 95% CI 1.27-2.47; P = 0.001), and progression-free survival of <2.7 months following second-line chemotherapy (HR 1.51, 95% CI 1.09-2.08; P = 0.012). A prognostic index was constructed, dividing patients into low- (0-1 factor), intermediate- (2 or 3 risk factors), or high- (4 risk factors) risk groups. Median survival times for each group were 11.8, 6.7, and 3.3 months, respectively (P < 0.00). Conclusions This analysis suggests that some clinico-pathologic factors might be helpful in identifying the subgroup of patients most likely to benefit from third-line chemotherapy for advanced gastric cancer. © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2011.