A Meta-Analysis Of Neoadjuvant Therapy On Advanced Gastric Cancer

BACKGROUND:Neoadjuvant therapy is an important part of the systemic treatments of locally advanced gastric cancer.Recently,many trials have been completed,but its value remains controversial.METHODS:We took systematic searches for all the published randomized or quasi-randomized controlled trials of neoadjuvant therapy compared with surgery alone on locally advanced stomach cancer.Database included Cochrane libraries of clinical comparative trials,Medline,Embase, Chinese National Knowledge Infrastructure(CNKI),Wanfang Database from 1978 to 2008 and the censor date was up to November 2008.Primary outcomes were relative risk(RR) on down-stage of tumor.Secondary outcomes include RR on overall survival and adverse effects of the two arms. Subgroup analysis and sensitivity analysis were also performed.All the calculations and statistical tests were done with the RevMan 5.0 software.RESULTS:About neoadjuvant chemotherapy(NAC),eleven trials involved of 1443 patients were enrolled.NAC group showed effect of down—staging of tumours(RR:1.42,95%CI:1.17 to 1.72),but with no statistical differences in RO resection rate(RR:1.09,95%CI:0.97 to 1.23).No statistical difference was found in the overall survival between the two groups(RR:1.07,95%CI:0.99 to 1.16).In a subset analysis of 4 trials of 211 patients confined to the stagesⅢandⅣ,NAC group(N=107) showed weak survival benefit better than surgery alone group(RR:1.72,95%CI: 1.05 to 2.80).Patients can benefit from the neoadjuvant radiotherapy on survival(RR 1.41,95%CI:1.15 to 1.73).No obvious adverse events were reported in those trials.CONCLUSIONS:With the available data,in gastric cancer,neoadjuvant chemotherapy is possible to dowstage tumor,but could not be confirmed to improve survival.New regimens and trials are encouraged to further explore the role of NAC in locally advanced stomach cancer.Neoadjuvant radiotherapy can improve survival in gastric cancer.