Prognostic value of chemotherapy-induced neutropenia in advanced gastric cancer patients undergoing first-line chemotherapy with DCF: a retrospective study

Objective: In this study, we investigated the correlation between the degree and timing of chemotherapyinduced neutropenia (CIN) caused by the DCF (docetaxel-platinum-fluorouracil) regimen as first-line chemotherapy and the survival of patients with advanced gastric cancer. Methods: We retrospectively analysed 110 patients diagnosed with advanced gastric cancer between 2007 and 2012 at our hospital who received 2 to 6 cycles of the DCF regimen as first-line chemotherapy. According to the CTCAE 4, CIN is categorized as G0, G1/2, G3, or G4. We stratified all patients into the following two groups based on the onset (timing) of CIN: early onset and late onset. Results: A total of 110 patients were included in this study. Among these patients, 15 (13.6%) did not exhibit CIN (grade 0), 54 (49.1%) experienced mild CIN (grade 1-2), 22 (20.0%) developed moderate CIN (grade 3), and 19 (17.3%) suffered from severe CIN (grade 4) during the first line of chemotherapy. The median progression-free survival (PFS) of the 110 patients was 6.0 months (95% CI: 5.5~6.6 months), and the median overall survival (OS) of the 110 patients was 12.7 months (95% CI: 11.2~14.2 months). According to a multivariate analysis, the hazard ratio of death was 0.59 (95% CI: 0.49-0.72, P=0.005) for patients with G1/2 CIN, 0.71 (95% CI: 0.52-0.90, P=0.001) for patients with G3 CIN, and 0.74 (95% CI: 0.46-0.93, P=0.023) for patients with G4 CIN compared with patients who did not suffer from neutropenia (G0). Conclusion: Patients who experienced G1/2 CIN had a more favourable treatment response and prognosis, whereas the absence of CIN predicted poor efficacy and survival, which may occur because the dose was ineffective. In addition, patients with G4 CIN did not exhibit better efficacy and prognosis, and the clinical outcomes were better for early-onset neutropenia than for late-onset neutropenia.