Abstract:

Objective To analyze the prognosis and efficacy related factors in patients with advanced gastric cancer. Methods The efficacy and prognosis
related factors of patients with advanced gastric cancer including clinical and pathological features， HER-2 gene expression， first-line and second-line regimen were analyzed. Results There were 192 patients with advanced gastric cancer enrolled from December 2008 to August 2011. One hundred and fifty-six patients receiving the first-line treatment of combined therapy were available for evaluation, and the response rate （RR） was 19.9％， and the RR of triple drug regimen was better than that of double drug regimen （27.0％ vs. 15.1％， P=0.008）. The RR of regimen containing targeted agent was much better than chemotherapy alone regimen （33.3％ vs.14.3％， P=0.012）. There were 108 cases receiving the secondline treatment， and the RR of 69 evaluatable patients was 13.0％. There were no significant difference in both RR and median time to progression （TTP） between the single-drug regimen and multi-drug regimen. Patients accepting the second-line treatment had significantly longer median overall survival （OS） compared with the first-line treatment （14.1 months vs. 7.3 months， P＜0.001）. HER-2 positive patients who received regimen containing trastuzumab obtained higherRR than chemotherapy alone regimen in the firstline treatment （45.4％ and 11.0％， P=0.008）. In the secondline treatment， the RR was 50.0％ and 10.0％ （P=0.009）， respectively. COX regression analysis showed that performance status， HER-2 expression， tumor burden and the second-line treatment were independent prognostic factors in patients with advanced gastric cancer. Logistic multiple regression analysis indicated that targeted therapy had significant impact on RR. Conclusion The triple drug regimen containing targeted drug can significantly improve the efficacy of advanced gastric cancer in the first-line treatment. Application of the second-line treatment will improve the prognosis significantly. HER-2 expression will influence the treatment option， and lead to significant difference in patient's prognosis.