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Title: Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry.
Authors: Jiménez Fonseca, Paula
Carmona-Bayonas, Alberto
Hernández, Raquel
Custodio, Ana
Cano, Juana Maria
Lacalle, Alejandra
Echavarria, Isabel
Macias, Ismael
Mangas, Monserrat
Visa, Laura
Buxo, Elvira
Álvarez Manceñido, Felipe
Viudez, Antonio
Pericay, Carles
Azkarate, Aitor
Ramchandani, Avinash
López, Carlos
Martinez de Castro, Eva
Fernández Montes, Ana
Longo, Federico
Sánchez Bayona, Rodrigo
Limón, Maria Luisa
Diaz-Serrano, Asun
Martin Carnicero, Alfonso
Arias, David
Cerdà, Paula
Rivera, Fernando
Vieitez, Jose Maria
Sánchez Cánovas, Manuel
Garrido, M
Gallego, J
metadata.dc.subject.mesh: Anthracyclines
Antineoplastic Combined Chemotherapy Protocols
Disease-Free Survival
Middle Aged
Odds Ratio
Receptor, ErbB-2
Stomach Neoplasms
Treatment Outcome
Issue Date: 1-Aug-2017
Abstract: The choice of chemotherapy in HER2-negative gastric cancer is based on centre's preferences and adverse effects profile. No schedule is currently accepted as standard, nor are there any factors to predict response, other than HER2 status. We seek to evaluate whether Lauren type influences the efficacy of various chemotherapies and on patient overall survival (OS). We have conducted a multicenter study in 31 hospitals. The eligibility criteria include diagnosis of stomach or gastroesophageal junction adenocarcinoma, HER2 negativity, and chemotherapy containing 2-3 drugs. Cox proportional hazards regression adjusted for confounding factors, with tests of 'treatment-by-histology' interaction, was used to estimate treatment effect. Our registry contains 1303 tumours analysable for OS end points and 730 evaluable for overall response rate (ORR). A decrease in ORR was detected in the presence of a diffuse component: odds ratio 0.719 (95% confidence interval (CI), 0.525-0.987), P=0.039. Anthracycline- or docetaxel-containing schedules increased ORR only in the intestinal type. The diffuse type displayed increased mortality with hazard ratio (HR) of 1.201 (95% CI, 1.054-1.368), P=0.0056. Patients receiving chemotherapy with docetaxel exhibited increased OS limited to the intestinal type: HR 0.65 (95% CI, 0.49-0.87), P=0.024, with no increment in OS for the subset having a diffuse component. With respect to progression-free survival (PFS), a significant interaction was seen in the effect of docetaxel-containing schedules, with better PFS limited to the intestinal type subgroup, in the comparison against any other schedule: HR 0.65 (95% CI, 0.50-0.85), P=0.015, and against anthracycline-based regimens: HR 0.64 (95% CI, 0.46-0.88), P=0.046. As a conclusion, in this registry, Lauren classification tumour subtypes predicted survival and responded differently to chemotherapy. Future clinical trials should stratify effect estimations based on histology.
metadata.dc.identifier.doi: 10.1038/bjc.2017.245
Appears in Collections:Producción 2020

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