Meta-analyses of randomized trials assessing the effect of neoadjuvant chemotherapy in locally advanced gastric cancer.

Abstract

4042 Background: With the development of more effective regimens, the use of neoadjuvant (preoperative) chemotherapy (CT) was considered to down-stage tumor and improves resectability. However, most reports of neoadjuvant CT for gastric cancer were inconclusive and produced confusing results. The objective of this analysis is to assess the effect of neoadjuvant CT in gastric cancer. Methods: By searching electronic databases (PubMed, EMBASE, CENTRAL, J-STAGE and CNKI) and ASCO, AACR proceedings, all randomized controlled trails (RCTs) which compared the effect of neoadjuvant CT combined surgery versus surgery alone in gastric cancer would be included. The primary outcome was overall survival (OS). Secondary outcomes included R0-resection rates, postoperative stage and complications. Hazard Ratio (HR) and Odds Ratio (OR) with fixed effect model were used for meta-analysis and were expressed with 95% confidence intervals (CI). Results: 8 RCTs with a total of 1447 patients were included. All patients had locally advanced but resectable gastric cancer and received 5-fluorouracil (5FU)-based CT. Compared to surgery alone, neoadjuvant CT was associated with a non-significant reduction in 1-year OS (HR: 0.57, 95%CI: 0.31-1.04, p = 0.07), and this trend became significant in 5-year OS (HR: 0.68, 95%CI: 0.48-0.97, p = 0.03). Furthermore, neoadjuvant CT resulted in higher R0-resection rate (OR: 1.67, 95%CI: 1.27-2.19, p = 0.0002) and less postoperative stage III-IV (HR: 0.54, 95%CI: 0.38-0.76, p = 0.0003). In terms of operative complications, there was no difference between the two arms (HR: 0.95, 95%CI: 0.67-1.35, p = 0.78). Conclusions: Neoadjuvant chemotherapy is effective for curative resection and downstaging of tumor, which significantly improved overall survival of locally advanced gastric cancer patients. No significant financial relationships to disclose.