This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chau, I. Articles by Ross, P. J. Search for Related Content PubMed PubMed Citation Articles by Chau, I. Articles by Ross, P. J. Related Articles Related Correspondence Social Bookmarking                            What's this?

Multivariate Prognostic Factor Analysis in Locally Advanced and Metastatic Esophago-Gastric Cancer—Pooled Analysis From Three Multicenter, Randomized, Controlled Trials Using Individual Patient Data

From the Department of Medicine, Department of Computing and Information, Royal Marsden Hospital, London and Surrey, UK

Address reprint requests to David Cunningham, MD, FRCP, Department of Medicine, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, UK; e-mail: david.cunningham{at}icr.ac.uk

PURPOSE: To identify baseline prognostic factors and assess whether pretreatment quality of life (QoL) predicts survival in patients with locally advanced or metastatic esophago-gastric cancer.

PATIENTS AND METHODS: Between 1992 and 2001, 1,080 patients were enrolled into three randomized, controlled trials assessing fluorouracil-based combination chemotherapy. All patients were required to complete the European Organization for Research and Treatment of Cancer core QoL questionnaire before random assignment.

RESULTS: Of the 1,080 patients randomly assigned, 979 (91%) died. Four independent poor prognostic factors were identified by multivariate analysis: performance status 2 (hazard ratio [HR], 1.58; 99% CI, 1.25 to 1.98), liver metastases (HR, 1.41; 99%CI, 1.14 to 1.74), peritoneal metastases (HR, 1.33; 99%CI, 1.01 to 1.74) and alkaline phosphatase 100 U/L (HR, 1.41; 99% CI, 1.14 to 1.76). A prognostic index was constructed dividing patients into good (no risk factor), moderate (one or two risk factors) or poor (three or four risk factors) risk groups. One-year survival for good, moderate, and poor risk groups were 48.5%, 25.7%, and 11%, respectively, and the survival differences among these groups were highly significant (P < .00001). Compared with the good risk group, the moderate risk group had nearly twice the risk of death, and the poor risk group had 3.5-fold increased risk of death. Pretreatment physical (P = .003), role functioning (P < .001), and global QoL (P < .001) predicted survival.

CONCLUSION: Four poor prognostic factors were identified and a simple prognostic index was devised. Information from this analysis can be used to aid clinical decision-making, help individual patient risk stratification, and serve as benchmark for the planning for future phase III trials.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Validation of the Royal Marsden Hospital Prognostic Index in Advanced Esophagogastric Cancer Using Individual Patient Data From the REAL 2 Study
  Ian Chau, Sue Ashley, and David Cunningham
  JCO 2009 27: 3-4 [Full Text]

This article has been cited by other articles:

				E. Basch, X. Jia, G. Heller, A. Barz, L. Sit, M. Fruscione, M. Appawu, A. Iasonos, T. Atkinson, S. Goldfarb, et al. Adverse Symptom Event Reporting by Patients vs Clinicians: Relationships With Clinical Outcomes J Natl Cancer Inst, November 17, 2009; (2009) djp386v1. [Abstract] [Full Text] [PDF]

				G. Corso, C. Pedrazzani, D. Marrelli, V. Pascale, E. Pinto, and F. Roviello Correlation of Microsatellite Instability at Multiple Loci With Long-term Survival in Advanced Gastric Carcinoma Arch Surg, August 1, 2009; 144(8): 722 - 727. [Abstract] [Full Text] [PDF]

				I. Chau, S. Ashley, and D. Cunningham Validation of the Royal Marsden Hospital Prognostic Index in Advanced Esophagogastric Cancer Using Individual Patient Data From the REAL 2 Study J. Clin. Oncol., July 1, 2009; 27(19): e3 - e4. [Full Text] [PDF]

				I. Chau, A. R. Norman, D. Cunningham, J. Oates, R. Hawkins, T. Iveson, M. Nicolson, P. Harper, M. Seymour, and T. Hickish The impact of primary tumour origins in patients with advanced oesophageal, oesophago-gastric junction and gastric adenocarcinoma--individual patient data from 1775 patients in four randomised controlled trials Ann. Onc., May 1, 2009; 20(5): 885 - 891. [Abstract] [Full Text] [PDF]

				R. Wong and D. Cunningham Optimising treatment regimens for the management of advanced gastric cancer Ann. Onc., April 1, 2009; 20(4): 605 - 608. [Full Text] [PDF]

				M. Dank, J. Zaluski, C. Barone, V. Valvere, S. Yalcin, C. Peschel, M. Wenczl, E. Goker, L. Cisar, K. Wang, et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction Ann. Onc., August 1, 2008; 19(8): 1450 - 1457. [Abstract] [Full Text] [PDF]

				F. Efficace, P. F. Innominato, G. Bjarnason, C. Coens, Y. Humblet, S. Tumolo, D. Genet, M. Tampellini, A. Bottomley, C. Garufi, et al. Validation of Patient's Self-Reported Social Functioning As an Independent Prognostic Factor for Survival in Metastatic Colorectal Cancer Patients: Results of an International Study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer J. Clin. Oncol., April 20, 2008; 26(12): 2020 - 2026. [Abstract] [Full Text] [PDF]

				C. C. Gotay, C. T. Kawamoto, A. Bottomley, and F. Efficace The Prognostic Significance of Patient-Reported Outcomes in Cancer Clinical Trials J. Clin. Oncol., March 10, 2008; 26(8): 1355 - 1363. [Abstract] [Full Text] [PDF]

				J Lee, T Lim, J. Uhm, K. Park, S. Park, S. Lee, J. Park, Y. Park, H. Lim, T. Sohn, et al. Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma Ann. Onc., May 1, 2007; 18(5): 886 - 891. [Abstract] [Full Text] [PDF]

				A. I. Sarela, S. Yelluri, and for the Leeds Upper Gastrointestinal Cancer Multid Gastric Adenocarcinoma With Distant Metastasis: Is Gastrectomy Necessary? Arch Surg, February 1, 2007; 142(2): 143 - 149. [Abstract] [Full Text] [PDF]

				S. S. Lee, J.-L. Lee, M.-H. Ryu, H. M. Chang, T. W. Kim, H.-J. Kang, W. K. Kim, J. S. Lee, and Y.-K. Kang Combination Chemotherapy with Capecitabine (X) and Cisplatin (P) as First Line Treatment in Advanced Gastric Cancer: Experience of 223 Patients with Prognostic Factor Analysis Jpn. J. Clin. Oncol., January 1, 2007; 37(1): 30 - 37. [Abstract] [Full Text] [PDF]

				W. Yeo, F. K. F. Mo, J. Koh, A. T. C. Chan, T. Leung, P. Hui, L. Chan, A. Tang, J. J. Lee, T. S. K. Mok, et al. Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma Ann. Onc., July 1, 2006; 17(7): 1083 - 1089. [Abstract] [Full Text] [PDF]

				F. Bonnetain, O. Bouche, P. Michel, C. Mariette, T. Conroy, D. Pezet, B. Roullet, J.-F. Seitz, B. Paillot, P. Arveux, et al. A comparative longitudinal quality of life study using the Spitzer quality of life index in a randomized multicenter phase III trial (FFCD 9102): chemoradiation followed by surgery compared with chemoradiation alone in locally advanced squamous resectable thoracic esophageal cancer Ann. Onc., May 1, 2006; 17(5): 827 - 834. [Abstract] [Full Text] [PDF]

				V. Goodell, L. G. Salazar, N. Urban, C. W. Drescher, H. Gray, R. E. Swensen, M. W. McIntosh, and M. L. Disis Antibody Immunity to the p53 Oncogenic Protein Is a Prognostic Indicator in Ovarian Cancer J. Clin. Oncol., February 10, 2006; 24(5): 762 - 768. [Abstract] [Full Text] [PDF]

				H. M. Mehanna and R. P. Morton Does Quality of Life Predict Long-term Survival in Patients With Head and Neck Cancer? Arch Otolaryngol Head Neck Surg, January 1, 2006; 132(1): 27 - 31. [Abstract] [Full Text] [PDF]

				Y. Kwok, W. F. Regine, and R. A. Patchell Radiation Therapy Alone for Spinal Cord Compression: Time to Improve Upon a Relatively Ineffective Status Quo J. Clin. Oncol., May 20, 2005; 23(15): 3308 - 3310. [Full Text] [PDF]

				I. Chau, A. R. Norman, D. Cunningham, D. Tait, P. J. Ross, T. Iveson, M. Hill, T. Hickish, F. Lofts, D. Jodrell, et al. A randomised comparison between 6 months of bolus fluorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer Ann. Onc., April 1, 2005; 16(4): 549 - 557. [Abstract] [Full Text] [PDF]