Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy.
PLoS One. 2013 Nov 12;8(11):e78544. doi: 10.1371/journal.pone.0078544. eCollection 2013.
Recently, a new classification for gastric cancer (GC) has been proposed, based on Lauren's histology and on anatomic tumour location, identifying three subtypes of disease: type 1 (proximal non diffuse GC), type 2 (diffuse GC) and type 3 (distal non diffuse GC). Aim of our analysis was to compare clinical outcome according to different GC subtypes (1,2,3) in metastatic GC patients receiving first-line chemotherapy.
Advanced GC pts treated with a first-line combination chemotherapy were included in our analysis. Pts were divided in three subgroups (type 1, type 2 and type 3) as previously defined.
A total of 248 advanced GC pts were included: 45.2% belonged to type 2, 43.6% to type 3 and 11.2% to type 1. Patients received a fluoropyrimidine-based chemotherapy doublet or three drugs regimens including a platinum derivate and a fluoropyrimidine with the addition of an anthracycline, a taxane or mytomicin C. RR was higher in type 1 pts (RR = 46.1%) and type 3 (34,3%) compared to type 2 (20,4%), (p = 0.015). Type 2 presented a shorter PFS, median PFS = 4.2 months, compared to type 1, mPFS = 7.2 months, and type 3, mPFS = 5.9 months (p = 0.011) and also a shorter OS (p = 0.022).
Our analysis suggests that GC subtypes may be important predictors of benefit from chemotherapy in advanced GC patients. Future clinical trials should take in account these differences for a better stratification of patients.
最近，基于 Lauren 的组织学和解剖肿瘤位置，提出了一种新的胃癌（GC）分类方法，将疾病分为三种亚型：1 型（近端非弥漫性 GC）、2 型（弥漫性 GC）和 3 型（远端非弥漫性 GC）。本分析的目的是比较转移性 GC 患者接受一线化疗时根据不同 GC 亚型（1、2、3）的临床结局。
纳入接受一线联合化疗的晚期 GC 患者进行分析。根据先前的定义，将患者分为三组（1 型、2 型和 3 型）。
共纳入 248 例晚期 GC 患者：45.2%属于 2 型，43.6%属于 3 型，11.2%属于 1 型。患者接受氟嘧啶类化疗二联或三联方案，包括铂类衍生物和氟嘧啶类药物，联合蒽环类药物、紫杉类或丝裂霉素 C。1 型（RR=46.1%）和 3 型（34.3%）的缓解率高于 2 型（20.4%）（p=0.015）。2 型患者的 PFS 较短，中位 PFS 为 4.2 个月，1 型 mPFS 为 7.2 个月，3 型 mPFS 为 5.9 个月（p=0.011），OS 也较短（p=0.022）。
本分析提示 GC 亚型可能是晚期 GC 患者化疗获益的重要预测因素。未来的临床试验应考虑这些差异，以更好地对患者进行分层。
