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Meta-Analysis
. 2023 Jun;27(6):1261-1276.
doi: 10.1007/s11605-023-05641-9. Epub 2023 Mar 7.

Systematic review and meta-analysis of the outcomes following neoadjuvant therapy in upfront resectable gastric cancers compared to surgery alone in phase III randomised controlled trials

Alva Lim Khai Shin  1 , Adelina Ho Si Ying  1 , Sarah Neo Hui Wen  1 , Shanwen Charleen Yeo  2 , Kon Voi Tay  3   4
Affiliations
Meta-Analysis

Systematic review and meta-analysis of the outcomes following neoadjuvant therapy in upfront resectable gastric cancers compared to surgery alone in phase III randomised controlled trials

Alva Lim Khai Shin et al. J Gastrointest Surg. 2023 Jun.

Abstract

Background: Gastric cancer is the fifth most common malignancy and the fourth most common cause of cancer mortality globally. The role of neoadjuvant chemotherapy in upfront resectable gastric cancer is a subject of ongoing research. In recent meta-analyses, R0 resection rate and superior outcomes were not consistently observed in such regimens.

Aim: To describe the outcomes following phase III randomised control trials; comparing neoadjuvant therapy followed by surgery against upfront surgery with and without adjuvant therapy in resectable gastric cancers.

Methods: The Cochrane Library, CINAHL, EMBASE, PubMed, SCOPUS and Web of Science was searched from January 2002 to September 2022.

Results: 13 studies were included (3280 participants). R0 resection rates were in neoadjuvant therapy arms as compared to adjuvant therapy with odds ratio (OR) 1.55[95% CI: 1.13, 2.13](p=0.007) and compared to surgery alone OR 2.49[95% CI: 1.56, 3.96](p=0.0001). 3-year and 5-year progression-, event- and disease-free survival in neoadjuvant therapy as compared to adjuvant therapy were not significantly increased, 3-year OR 0.87[0.71, 1.07](p=0.19). Meanwhile, comparing neoadjuvant therapy to adjuvant therapy, 3-year overall survival (OS) hazard ratio was 0.88[95% CI: 0.70, 1.11](p=0.71) while 3- and 5-year OS OR was 1.18[95% CI: 0.90, 1.55], p=0.22 and 1.27[95% CI: 0.67, 2.42](p=0.47) respectively. Surgical complications were also more common with neoadjuvant therapy.

Conclusion: Neoadjuvant therapy yields higher rates of R0 resection. However, improved long-term survival was not seen as compared to adjuvant therapy. Large multi-centred randomised control trials with D2 lymphadenectomy should be performed to better evaluate the treatment modalities.

Keywords: Complications; Gastric cancer; Neoadjuvant therapy; Outcomes; Stomach neoplasms.

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References

    1. Takahashi T, Saikawa Y, Kitagawa Y. Gastric Cancer: Current Status of Diagnosis and Treatment. Cancers (Basel). 2013;5:48–63. - PubMed - PMC - DOI
    1. Sitarz R, Skierucha M, Mielko J, Offerhaus JA, Maciejewski R, Polkowski WP. Cancer Management and Research Dovepress Gastric cancer: epidemiology, prevention, classification, and treatment. Cancer Manag Res. 2018;10 239.
    1. Coccolini F, Montori G, Ceresoli M, Nita GE, Ansaloni L, Cima S, et al. Advanced gastric cancer: what we know and what we still have to learn peritoneal; Surgery; Definition. World J Gastroenterol. 2016;22:1139–59. - PubMed - DOI
    1. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114–24. - PubMed - DOI
    1. Johnston FM, Beckman M. Updates on Management of Gastric Cancer. Curr Oncol Rep. 2019;21:67. - PubMed - DOI

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