Koo DH, Ryu MH, Lee MY, Moon MS, Kang YK. New prognostic model for patients with advanced gastric cancer: Fluoropyrimidine/platinum doublet for first-line chemotherapy. World J Gastroenterol 2021; 27(48): 8357-8369 [PMID: 35068874 DOI: 10.3748/wjg.v27.i48.8357]
Corresponding Author of This Article
Yoon-Koo Kang, MD, PhD, Professor, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. ykkang@amc.seoul.kr
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 28, 2021; 27(48): 8357-8369 Published online Dec 28, 2021. doi: 10.3748/wjg.v27.i48.8357
New prognostic model for patients with advanced gastric cancer: Fluoropyrimidine/platinum doublet for first-line chemotherapy
Dong-Hoe Koo, Min-Hee Ryu, Mi-Yeon Lee, Mee-Sun Moon, Yoon-Koo Kang
Dong-Hoe Koo, Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
Min-Hee Ryu, Mee-Sun Moon, Yoon-Koo Kang, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Mi-Yeon Lee, Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Seoul 03181, South Korea
Author contributions: Koo DH, Ryu MH, and Kang YK contributed to the conception and design of the study; Kang YK, Ryu MH, and Moon MS collected the data; Koo DH, Lee MY, Kang YK, and Ryu MH performed the analysis; Koo DH, Ryu MH, and Kang YK wrote the paper; all authors contributed to manuscript revision and read and approved the submitted version.
Institutional review board statement: The Institutional Review Board of Asan Medical Center approved the study protocol (2020-0574).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No conflicts of interest relevant to this article are reported.
Data sharing statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to a privacy issue from the patients.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yoon-Koo Kang, MD, PhD, Professor, Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. ykkang@amc.seoul.kr
Received: July 12, 2021 Peer-review started: July 12, 2021 First decision: October 3, 2021 Revised: October 9, 2021 Accepted: November 30, 2021 Article in press: November 30, 2021 Published online: December 28, 2021 Processing time: 164 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background
Since systemic chemotherapy for metastatic or recurrent gastric cancer (MRGC) has become standardized, prognostic factors for MRGC patients should be investigated in patients who receive fluoropyrimidine/platinum doublet chemotherapy, which is considered the standard first-line treatment for human epidermal growth factor receptor 2-negative MRGC.
Research motivation
The neutrophil-lymphocyte ratio (NLR) is a representative blood marker of the systemic inflammatory response that reflects tumor progression, invasion, and metastasis in cancer patients. This is a relatively new prognostic factor in MRGC, and its change was reported to predict poor outcomes during immuno-oncologic therapy.
Research objectives
We modified our previous prognostic model by introducing NLR and histology using a cohort of MRGC patients, and we validated our new model in a different cohort.
Research methods
Model development and validation were based on a split-sample method according to time period. Patients were separated by treatment period and assigned to a training set (2012-2015; n = 937) or an independent validation set (2008-2011; n = 946). The prognostic model was developed using the training set.
Research results
Multivariate analysis confirmed that six factors were significantly associated with poor overall survival as follow: poor performance, peritoneal metastasis, bone metastasis, high alkaline phosphatase level, low albumin level, and high NLR. The observed overall survival and progression-free survival curves in patients in each risk category showed significant differences in both the training and validation sets (P < 0.001, log-rank test).
Research conclusions
We identified six factors readily measured in clinical practice and predictive of poor prognosis in patients with MRGC. Our new prognostic model uses a scoring system that incorporates those six factors and could be used to classify patients into three groups with significantly different survival outcomes.
Research perspectives
Our model could help to predict life expectancy, guide treatment plans, analyze the findings of clinical studies, and support the design of future clinical trials in MRGC patients.
