Prognostic factors in Japanese patients with advanced gastric cancer using the data from JCOG9912 study.

Abstract

4059 Background: In advanced gastric cancer (AGC), there is no globally accepted prognostic scoring systems. A prognostic index was proposed by the Royal Marsden Hospital (RMH) which consists of four independent prognostic factors: PS, peritoneal metastases, liver metastases, and ALP (J Clin Oncol 2004). However, RMH index was developed by the data of Western pts and 30% of the included pts had esophageal cancer. Therefore we explored baseline prognostic factors in Japanese AGC pts using the data from a phase III trial (JCOG9912, Lancet Oncol 2009). Methods: The pts analyzed were those with complete data available for multivariate analyses using Cox proportional hazard model. Results: Six hundred fifty (92.5%) out of the 703 pts of JCOG9912 were included, who received either 5-FU (n=215), irinotecan plus cisplatin (n=216) or S-1 (n=219). Of the 650 pts, 607 died. The median survival time for all analyzed pts was 11.8 months. Multivariate analysis detected seven independent prognostic factors: sex, PS, number of metastatic sites, prior gastrectomy, bone metastasis, lung metastasis, and CRP. Three of 4 prognostic factors used in the RMH index (peritoneal metastasis, liver metastasis and ALP) were not significant. Conclusions: From the data of Japanese AGC pts, seven independent prognostic factors were identified. PS was the only common factor with RMH prognostic index. We plan to propose another prognostic index using our prognostic factors. Covariates HR 95% CI Two-sided p Bone metastasis Yes (vs. no) 2.09 1.30-3.35 < 0.01 PS* 1, 2 (vs. 0) 1.47 1.24-1.74 < 0.01 Number of metastatic sites ≥ 2 (vs. 0, 1) 1.44 1.08-1.93 0.01 Sex Female (vs. male) 1.29 1.05-1.58 0.02 CRP ≥ULN (vs. <ULN) 1.23 1.03-1.48 0.03 Prior gastrectomy Yes (vs. no) 0.74 0.55-0.99 0.04 Lung metastasis Yes (vs. no) 0.72 0.53-1.00 0.05 ALP* ≥ULN (vs. <ULN) 1.13 0.93-1.38 0.21 Peritoneal metastases* Yes (vs. no) 1.03 0.81-1.31 0.81 Liver metastases* Yes (vs. no) 1.02 0.78-1.33 0.90 * Factors from RMH index.