Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Gastroenterology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
ESMO Open. 2021 Oct;6(5):100234. doi: 10.1016/j.esmoop.2021.100234. Epub 2021 Aug 27.
The Japan Clinical Oncology Group (JCOG) prognostic index, consisting of performance status, primary tumor resected, number of metastases, and serum alkaline phosphatase, has been one of the robust prognostic indices for patients with advanced gastric cancer on the basis of which clinical trials have stratified prognosis. Only a few studies, however, have utilized the JCOG prognostic index in daily practice.
We conducted a retrospective study on patients with advanced gastric cancer who received first-line platinum-containing chemotherapy at a single institute between 2011 and 2017. Prognostic factors were evaluated using a Cox proportional regression model.
A total of 608 patients were enrolled. Multivariate analysis showed that performance status ≥1, presence or absence of primary tumor, serum alkaline phosphatase, neutrophil-to-lymphocyte ratio ≥4, and diffuse-type histology were significantly associated with worse prognosis, whereas the number of metastases was not. Although the original prognostic index could not adequately stratify patients into three risk groups, the modified index (good: 0 and 1, moderate: 2 and 3, poor: 4-6), which was established by incorporating diffuse-type histology and high neutrophil-to-lymphocyte ratio, demonstrated excellent stratification. The median overall survival of the good (n = 315), moderate (n = 243), and poor (n = 54) risk groups was 20.5, 13.5, and 10.2 months, respectively. Hazard ratios (HRs) were 1.69 [95% confidence interval (CI), 1.40-2.04; good versus moderate] and 1.52 (95% CI, 1.11-2.08; moderate versus poor). This novel index also demonstrated a statistically significant stratification of survival after progression following first-line chemotherapy (good versus moderate: HR, 1.41; 95% CI, 1.16-1.70; moderate versus poor: HR, 2.00; 95% CI, 1.45-2.74).
The modified JCOG prognostic index showed excellent stratification of overall survival in real-world patients, which could also help determine the need for treatment changes throughout the continuum of chemotherapy.
日本临床肿瘤学组（JCOG）预后指数包括体能状态、原发肿瘤切除情况、转移灶数量和血清碱性磷酸酶，是基于该指数对晚期胃癌患者进行分层预后的强有力的预后指标之一。然而，仅有少数研究在日常实践中使用 JCOG 预后指数。
我们对 2011 年至 2017 年期间在一家单中心接受一线含铂化疗的晚期胃癌患者进行了回顾性研究。使用 Cox 比例风险回归模型评估预后因素。
共纳入 608 例患者。多因素分析显示，体能状态≥1、有无原发肿瘤、血清碱性磷酸酶、中性粒细胞与淋巴细胞比值≥4 和弥漫型组织学与预后较差显著相关，而转移灶数量则无显著相关性。虽然原始预后指数不能充分将患者分为三组，但通过纳入弥漫型组织学和高中性粒细胞与淋巴细胞比值建立的改良指数（良好：0 和 1，中度：2 和 3，不良：4-6）则具有出色的分层能力。良好（n=315）、中度（n=243）和不良（n=54）风险组的中位总生存期分别为 20.5、13.5 和 10.2 个月。风险比（HRs）分别为 1.69（95%置信区间（CI），1.40-2.04；良好与中度）和 1.52（95%CI，1.11-2.08；中度与不良）。该新指数在一线化疗后进展后生存的分层中也具有统计学意义（良好与中度：HR，1.41；95%CI，1.16-1.70；中度与不良：HR，2.00；95%CI，1.45-2.74）。
改良的 JCOG 预后指数在真实世界患者中具有出色的总生存期分层能力，这也有助于在化疗全程中确定治疗改变的必要性。
