Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis

Abstract

To clarify the effect of neoadjuvant chemotherapy (NAC) on the survival outcomes of operable gastric cancers, we searched PubMed, Embase, and Cochrane Library for randomized clinical trials published until June 2014 that compared NAC-containing strategies with NAC-free strategies in patients with adenocarcinoma of the stomach or the esophagogastric junction, who had undergone potentially curative resection. The adjusted pooled hazard ratio (HR) for overall survival (OS) was insignificant when comparing the NAC-containing arm with the NAC-free arm. Subgroup analysis showed that the OS of the treatment arm that involved both adjuvant chemotherapy (AC) and NAC was significantly improved over the control arm (AC only) (HR = 0.48, 95% CI: 0.35–0.67; P < 0.001). While NAC alone plus surgery did not show any survival benefit over surgery alone. Perioperative chemotherapy (PC) also showed a significant increase in PFS and a significant reduction in distant metastasis compared to surgery alone. Therefore, in patients with resectable gastric cancer, NAC alone is not enough and AC alone is not good enough to definitely improve their OS. Collectively, PC combined with surgery could maximize the survival benefit for patients with resectable gastric cancer.

Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis

“…However chemotherapy given prior to surgery may reduce tumor burden and eradicate micrometastatic foci outside the surgical field [ 7 , 8 ]. Several studies have emphasized the survival benefits of PC to the patients [ 9 , 10 ]. However, chemortherapy given prior to surgery can cause fibrosis and tissue edema, which may cause difficulties during surgery [ 11 ], causing adverse effects to the patients [ 12 , 13 ].…”

Shikonin induces mitochondria-mediated apoptosis and enhances chemotherapeutic sensitivity of gastric cancer through reactive oxygen species

“…It ranks fifth in tumour incidence rate and third in cancer mortality worldwide23. Although surgery is the main curative therapy for stomach cancer, chemotherapy still has an important role, as many patients have regional or distant spread at the time of diagnosis456. Fluorouracil or its analogues, platinum or its derivatives, and paclitaxel are regarded as first-line therapies of gastric cancer7.…”

Gastric cancer adjuvant therapy

“…In addition, a recently published metaanalysis suggests that in patients with resectable gastric cancer, neoadjuvant chemotherapy alone is not effective enough and adjuvant chemotherapy alone is also not good enough to definitely improve overall survival. Perioperative chemotherapy combined with surgery is better to achieve a survival benefit for patients with resectable gastric cancer [21] Smaller studies including docetaxel into neoadjuvant chemotherapy regimens suggest an optimized histopathological complete response rate which amounts to 15% in recently published pooled analysis. Additionally, complete histopathological response seems to be associated with better disease-free and overall survival outcomes [22].…”