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Meta-Analysis
. 2010 Nov 28;16(44):5621-8.
doi: 10.3748/wjg.v16.i44.5621.

Neoadjuvant chemotherapy for advanced gastric cancer: a meta-analysis

Wei Li  1 , Jing Qin, Yi-Hong Sun, Tian-Shu Liu
Affiliations
Meta-Analysis

Neoadjuvant chemotherapy for advanced gastric cancer: a meta-analysis

Wei Li et al. World J Gastroenterol. .

Abstract

Aim: To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.

Methods: All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched. Studies that included patients with metastases at enrollment were excluded. Databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, and American Society of Clinical Oncology meeting abstracts from 1978 to 2010. The censor date was up to April 2010. Primary outcome was the odds ratio (OR) for improving overall survival rate of patients with advanced gastric cancer. Secondary outcome was the OR for down-staging tumor and increasing R0 resection in patients with advanced gastric cancer. Safety analyses were also performed. All calculations and statistical tests were performed using RevMan 5.0 software.

Results: A total of 2271 patients with advanced gastric cancer enrolled in 14 trials were divided into NAC group (n = 1054) and control group (n = 1217). The patients were followed up for a median time of 54 mo. NAC significantly improved the survival rate [OR = 1.27, 95% confidence interval (CI): 1.04-1.55], tumor stage (OR = 1.71, 95% CI: 1.26-2.33) and R0 resection rate (OR = 1.51, 95% CI: 1.19-1.91) of patients with advanced gastric cancer. No obvious safety concerns were raised in these trials.

Conclusion: NAC can improve tumor stage and survival rate of patients with advanced gastric cancer with a rather good safety.

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Figures

Figure 1
Figure 1
Overall survival rates of patients with advanced gastric cancer in 12 studies (A), 3-year progression-free rates in 3 studies (B), tomor down-staging rates in 6 studies (C), R0 resection rates in 8 studies (D), and adverse effects of neoadjuvant chemotherapy (E). NAC: Neoadjuvant chemotherapy; PFS: Progression-free survival; CI: Confidence interval.
Figure 2
Figure 2
Subgroup analysis showing different overall survival rates of patients with advanced gastric cancer in trials from Western and Asian counties. NAC: Neoadjuvant chemotherapy; IV: Intravenous; IA: Intra-arterial.
Figure 3
Figure 3
Odds ratio (A) and publication bias (B) in studies included in this study. A: Sensitivity analysis for overall survival: high-quality studies (Jadad score ≥ 4); B: Funnel plot analysis of potential publication bias.
See this image and copyright information in PMC

Comment in

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