Neutropenia predicts better prognosis in patients with metastatic gastric cancer on a combined epirubicin, oxaliplatin and 5-fluorouracil regimen

// Rujiao Liu 1, 2, * , Mingzhu Huang 1, 2, * , Xiaoying Zhao 1, 2 , Wei Peng 1, 2 , Si Sun 1, 2 , Jun Cao 1, 2 , Dongmei Ji 1, 2 , Chenchen Wang 1, 2 , Weijian Guo 1, 2 , Jin Li 1, 2 , Jiliang Yin 1, 2 , Xiaodong Zhu 1, 2 1 Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China * These authors have contributed equally to this work Correspondence to: Xiaodong Zhu, e-mail: xddr001@163.com Keywords: metastatic gastric cancer, EOF5 regimen, chemotherapy-induced neutropenia, overall survival, progression-free survival Received: April 21, 2015      Accepted: October 06, 2015      Published: October 16, 2015 ABSTRACT Chemotherapy-induced neutropenia (CIN) reportedly indicated better prognosis for some cancers. We retrospectively analyzed 150 evaluable metastatic gastric cancer (MGC) patients who had received first-line EOF5 (combination regimen of epirubicin, oxaliplatin and 5-day continuous infusion of 5-fluorouracil) treatment. We divided patients into three groups according to the worst grade of CIN: absent group (grade 0), moderate group (grade 1–2) and severe group (grade 3–4). Multivariate analyses of overall survival (OS) proved moderate and severe CIN were important prognostic factors whether regarding CIN as a time-varying covariate (TVC) or not. Compared with absent CIN, hazard ratio (HR) for moderate and severe CIN were 0.31 (95% confidential interval (CI): 0.17–0.55; P < 0.001) and 0.36 (95% CI: 0.20–0.64; P = 0.001) respectively with TVC; and were 0.31 (95% CI: 0.17–0.56; P < 0.001) and 0.34 (95% CI: 0.19–0.61; P < 0.001) respectively without TVC. In progression-free survival (PFS) analyses, moderate and severe CIN showed similar results. In the landmark group ( n = 122 patients) analyses with TVC, moderate and severe CIN remained prognostic factors for PFS, while only moderate CIN was prognostic factor for OS. CIN predicted longer OS and PFS in MGC patients treated with first-line EOF5 chemotherapy.