Perioperative versus adjuvant chemotherapy for resectable gastric cancer: a meta-analysis of randomized controlled trials.

IF 3.5 3区医学 Q2 ONCOLOGY Frontiers in Oncology Pub Date : 2025-03-06 eCollection Date: 2025-01-01 DOI:10.3389/fonc.2025.1432596

Haiya Ou, Jiamei Zhuang, Mingwei Jian, Xinyi Zheng, Tingping Wu, Honghui Cheng, Rui Qian

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Abstract

Objectives: To report the latest systematic review and meta-analysis of randomized controlled trials (RCT) to compare perioperative versus adjuvant chemotherapy for resectable gastric cancer.

Methods: We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April, 2024 for RCT which compared perioperative versus adjuvant chemotherapy for resectable gastric cancer. Outcomes measured were overall survival (OS) and progression-free survival (PFS).

Results: 5 RCTs including 2,735 patients were included for meta-analysis. Meta-analysis revealed a significant longer PFS in the neoadjuvant chemotherapy (NAC) group (HR: 0.77; 95% CI: 0.69, 0.85; P<0.00001) compared with adjuvant chemotherapy (AC) group. Subgroup analysis found that there was still a significant superiority of NAC in female (HR: 0.53; 95% CI: 0.40, 0.70; P<0.0001) and cN+ (HR: 0.77; 95% CI: 0.67, 0.89; P=0.0005) patients, while the superiority disappeared in male (HR: 0.87; 95% CI: 0.74, 1.01; P=0.07) and cN- patients (HR: 0.91; 95% CI: 0.46, 1.78; P=0.77). In addition, meta-analysis observed a trend towards improved OS with NAC (HR: 0.86; 95% CI: 0.70, 1.07; P = 0.17), and sensitivity analysis demonstrated instability in OS.

Conclusions: NAC can significantly prolong PFS in patients with resectable gastric cancer compared to AC, and the benefit is more significant in women and cN+ patients. Besides, our analysis indicated that NAC has a potential to improve OS compared with AC.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024546165.

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可切除胃癌的围手术期与辅助化疗：随机对照试验的荟萃分析。

目的：报道随机对照试验（RCT）的最新系统评价和荟萃分析，以比较可切除胃癌的围手术期和辅助化疗。方法：我们通过PubMed、Embase、Web of Science、Cochrane等网站系统检索到2024年4月的可切除胃癌围手术期与辅助化疗的RCT比较文献。测量的结果是总生存期（OS）和无进展生存期（PFS）。结果：纳入5项rct，共2735例患者进行meta分析。荟萃分析显示，新辅助化疗（NAC）组的PFS明显更长(HR: 0.77；95% ci: 0.69, 0.85；PPP=0.0005)，男性患者优势消失(HR: 0.87；95% ci: 0.74, 1.01；P=0.07)和cN-患者(HR: 0.91；95% ci: 0.46, 1.78；P = 0.77)。此外，meta分析观察到NAC患者有改善OS的趋势(HR: 0.86；95% ci: 0.70, 1.07；P = 0.17)，敏感性分析显示OS不稳定。结论：与AC相比，NAC可显著延长可切除胃癌患者的PFS，且在女性和cN+患者中获益更为显著。此外，我们的分析表明，与ac相比，NAC具有改善OS的潜力。系统评价注册：https://www.crd.york.ac.uk/PROSPERO/，标识符CRD42024546165。

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来源期刊

Frontiers in Oncology Biochemistry, Genetics and Molecular Biology-Cancer Research

CiteScore

6.20

自引率

10.60%

发文量

6641

审稿时长

14 weeks

期刊介绍： Cancer Imaging and Diagnosis is dedicated to the publication of results from clinical and research studies applied to cancer diagnosis and treatment. The section aims to publish studies from the entire field of cancer imaging: results from routine use of clinical imaging in both radiology and nuclear medicine, results from clinical trials, experimental molecular imaging in humans and small animals, research on new contrast agents in CT, MRI, ultrasound, publication of new technical applications and processing algorithms to improve the standardization of quantitative imaging and image guided interventions for the diagnosis and treatment of cancer.