Neoadjuvant Chemotherapy In Gastric Cancer: A Systematic Review And Meta-Analysis

There's no consensus of opinion and standard about neoadjuvant chemotherapy for locally advanced gastric cancer. There is still controversy over its efficacy and safety. This systematic review and meta-analysis were performed to assess the efficacy and survival benefit of neoadjuvant chemotherapy in patients with locally advanced gastric cancer.Randomized controlled trials (RCTs) on neoadjuvant chemotherapy (NAC) versus none in locally advanced gastric cancer were identified by electronic searches of PubMed, Web of Knowledge, Ovid, Elsevier, EMBASE, the Cochrane Controlled Trials Register, Cancerlit, Chinese Scientific Journal Full-text Database (CSJD), Chinese Journal Full-text Database (CJFD), Wanfang Data System and Chinese Biomedical Literature Database (CBM); hand searches of relevant abstracts and reference lists; and contact to experts. Two investigators evaluated the retrieved RCTs and collected data independently. R0 resection rate and overall survival rate were the primary outcome measure. Meta-analysis was carried out with RevMan 5.0.Seven RCTs were selected. A total of 1387 patients were available for analysis, with 648 in the neoadjuvant chemotherapy plus surgery group and 739 in the surgery alone group. As to RO resection, an odds ratio of 1.47 (95 per cent c.i.0.92 to 2.34) was obtained. The NAC group tended to have a higher RO resection rate (p=0.11). The pooled HR for overall survival was 0.74 (95 per cent c.i.0.63 to 0.88), which was significantly in favour of NAC (p=0.0006). The pooled HR for disease free survival was 0.66 (95 per cent c.i.0.56 to 0.77), also favouring NAC (p<0.00001).Neoadjuvant chemotherapy might increase the R0 resection rate and the overall survival rate of patients with locally advanced gastric cancer. Well-designed RCTs are still needed to confirm its efficacy and survival benefit.