Clinical variables evaluated before the start of Gem/Cape associated with a higher risk of progression at univariate analysis included: ECOG PS ≥1 (p <.0005), lung metastases (p.040), lymph-node metastases (p.015), neutrophils >70% (p.015), lymphocytes <20% (p.009), neutrophils/lymphocytes ratio (NLR) ≥5 (p.015), Hb <12 g/dl (p.017), ALI index lower than 40 (median value) (p.038), and low mitotane concentrations during Gem/Cape chemotherapy (p.036). The gene discussed is GSTM1; the disease is metastatic malignant neoplasm in the lymph nodes.