The Efficacy And Safety Of Perioperative Chemotherapy Versus Adjuvant Chemotherapy For Gastric Cancer:a Meta-analysis

Objective:The aim of this study was to performed a meta-analysis to comparing efficacy and safety of perioperative chemotherapy(PCT)between adjuvant chemotherapy(ACT)for patients with gastric cancer.Methods:Randomized controlled trials(RCTs)of perioperative chemotherapy versus adjuvant chemotherapy for gastric cancer were searched in PubMed,Embase,Cochrane library,CNKI,Wanfang and other databases,from January 2000 to October 2018.The main endpoints were survival rate,RO resection rate,adverse event rate,and chemotherapy completion rate.Two researchers independently screened literature,evaluated included literature quality and extracted data.Statistical analyses were done by RevMan 5.3 software.Results:Nine randomized controlled trials involving 1369 patients were included.There were 659 patients in the perioperative chemotherapy group and 710 patients in the adjuvant chemotherapy group.Meta-analysis showed that there was no significant difference in 5-year survival rate between the perioperative chemotherapy group and the adjuvant chemotherapy group(HR=1.16,95%CI:0.9-1.5,P=0.24).Two groups showed differences in R0 resection rate(OR=1.46,95%CI:1.01-2.09,P=0.04),adverse event rate(OR=0.68,95%CI:0.46-1.00,P=0.05),chemotherapy completion rate(OR=3.63,95%CI:1.92-6.90,P<0.0001),with statistical significances.Conclusion:Compared with adjuvant chemotherapy,perioperative chemotherapy didn't improve 5-year survival in patients with gastric cancer.However,perioperative chemotherapy increased R0 resection rate,reduced the incidence of adverse events,and had a higher rate of chemotherapy completion.