The optimal strategy of multimodality therapies for resectable gastric cancer: evidence from a network meta-analysis
The optimal strategy of multimodality therapies for resectable gastric cancer: evidence from a network meta-analysis
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可切除胃癌多模式治疗的最佳策略：来自网络荟萃分析的证据
DOI：
10.7150/jca.30456
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发表时间：
2019-06
影响因子：
3.9
通讯作者：
Xu Huimian
中科院分区：
文献类型：
--
作者：
Yin Songcheng;Wang Pengliang;Xu Xiaoyu;Tan Yuen;Huang Jinyu;Xu Huimian
背景：关于可切除胃癌综合治疗的最佳策略仍存在争议。该网络荟萃分析的目的是通过整合直接和间接方法确定手术联合新辅助或辅助化疗（CT）、放疗（RT）和放化疗（CRT）的疗效。方法：通过Medline、Embase、CENTRAL和PMC数据库对随机对照试验（RCT）进行系统检索。总生存期（OS）是关注的主要结局。进行贝叶斯网络荟萃分析，并根据其改善生存率的有效性对治疗进行排名。结果：共纳入五十六篇随机对照试验，涉及12,435例患者。总体分析显示，与辅助CT、辅助RT、辅助CRT、新辅助CT、新辅助RT和单独手术相比，新辅助CRT的OS在统计学上显著更好。此外，D2淋巴结切除术的亚组分析显示，新辅助CRT并不显著上级优于新辅助CT（HR = 0.67，95%CrI 0.41-1.08）、辅助CRT（HR = 0.67，95%CrI 0.37-1.21）和辅助CT（HR = 0.60，95%CrI 0.35-1.04）。随着生存获益的趋势，新辅助CRT有89%的概率成为最佳选择。结论：我们的研究表明，新辅助CRT没有显著的生存优势，尽管观察到最佳治疗的可能性最高。进一步的临床试验是必要的，以确定新辅助CRT的价值，特别是在D2淋巴结清扫亚组。
Background: Controversy continues regarding the optimal strategy of multimodality therapies for resectable gastric cancer. The aim of this network meta-analysis was to determine the efficacy of surgery combined with neoadjuvant or adjuvant chemotherapy (CT), radiotherapy (RT), and chemoradiotherapy (CRT) by integrating the direct and indirect method. Methods: A systematic search for randomized controlled trials (RCTs) was performed through Medline, Embase, CENTRAL, and PMC databases. Overall survival (OS) was the primary outcome of interest. A Bayesian network meta-analysis was conducted and treatments were ranked based on their effectiveness for improving survival. Results: Fifty-six RCTs involving 12,435 patients were included. Overall analysis showed that neoadjuvant CRT resulted in a statistically significantly better OS compared with adjuvant CT, adjuvant RT, adjuvant CRT, neoadjuvant CT, neoadjuvant RT, and surgery alone. Moreover, subgroup analysis of D2 lymphadenectomy revealed that neoadjuvant CRT was not significant superior to neoadjuvant CT (HR = 0.67, 95% CrI 0.41-1.08), adjuvant CRT (HR = 0.67, 95% CrI 0.37-1.21), and adjuvant CT (HR = 0.60, 95% CrI 0.35-1.04). With a tendency to survival benefit, neoadjuvant CRT had an 89% probability of being the best selection. Conclusions: Our study showed no significant survival advantage for neoadjuvant CRT, though the highest probability of being the best treatment was observed. Further clinical trials are essential to determine the value of neoadjuvant CRT, especially in D2 lymphadenectomy subgroup.
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DOI：
10.1016/s0739-5930(08)70072-2
发表时间：
2007
期刊：
Yearbook of Gastroenterology
影响因子：
--
作者：
Edith Rodríguez Braun;Alejandro Pérez Fidalgo
通讯作者：
Edith Rodríguez Braun;Alejandro Pérez Fidalgo
DOI：
10.1016/s1278-3218(02)00178-6
发表时间：
2002-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
J. Macdonald;S. Smalley;J. Benedetti;S.A Hundhal;N. Estes;G.N Stemmermannn;D. Haller;J. Ajani-
通讯作者：
J. Macdonald;S. Smalley;J. Benedetti;S.A Hundhal;N. Estes;G.N Stemmermannn;D. Haller;J. Ajani-
影响因子：
45.3
作者：
Park, Se Hoon;Sohn, Tae Sung;Kang, Won Ki
通讯作者：
Kang, Won Ki
DOI：
10.1016/j.yonc.2011.08.020
发表时间：
2011
期刊：
Yearbook of Oncology
影响因子：
--
作者：
J. Thigpen
通讯作者：
J. Thigpen
影响因子：
45.3
作者：
Dikken, Johan L.;Jansen, Edwin P. M.;Verheij, Marcel
通讯作者：
Verheij, Marcel