Multivariate prognostic index and triplet regimen efficacy predictive index in locally advanced and metastatic gastric cancer: pooled analysis from three clinical trials using individual patient data

Wan-Jing Feng ^1,2, Xiao-Ying Zhao ^1,2, Yi-Fu He ³

⁰Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China.

Therapeutic Advances in Medical Oncology +

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February 29, 2024

View abstract on PubMed

Summary

A new Fudan advanced gastric cancer prognostic risk score (FARS) index effectively predicts overall survival (OS) in advanced gastric cancer patients. The TRIS index identifies patients who benefit most from triplet chemotherapy regimens, aiding clinical decisions.

Area Of Science

Oncology
Clinical Trials
Biostatistics

Background

Advanced gastric cancer (AGC) poses significant challenges in predicting patient outcomes.
Effective prognostic tools are crucial for guiding treatment strategies in AGC.

Purpose Of The Study

To develop a prognostic index for overall survival (OS) in advanced gastric cancer (AGC) patients.
To identify factors predicting efficacy of triplet chemotherapy regimens in AGC.

Main Methods

Analysis of 679 patients from three clinical trials (2 phase III, 1 phase II).
Utilized 11 clinicopathological and 14 hematological parameters.
Employed univariate/multivariate Cox analyses and nomogram construction.

Main Results

Identified seven prognostic factors for OS, including tumor site, histology (signet-ring cell carcinoma/mucinous carcinoma), metastasis, neutrophil, lymphocyte, LDH, and ALP levels.
Developed the Fudan advanced gastric cancer prognostic risk score (FARS) index, demonstrating significant OS prediction (AUCs 0.70-0.77).
Identified three factors (histology, tumor site, neutrophil count) for triplet regimen efficacy (TRIS index), showing improved OS with triplet vs. doublet therapy in specific patient groups.

Conclusions

The FARS index provides a validated tool for OS prediction and risk stratification in AGC.
The TRIS index aids in selecting patients likely to benefit from triplet chemotherapy, supporting personalized treatment decisions.

Keywords:

advanced gastric cancer chemotherapy overall survival prognostic index triplet regimen efficacy predictive index