Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.
Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.
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对于可手术的胃癌，围手术期化疗比辅助化疗更能提高总生存率：更新的荟萃分析
DOI：
10.1038/srep12850
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发表时间：
2015-08-05
影响因子：
4.6
通讯作者：
Liu L
中科院分区：
文献类型：
--
作者：
Yang Y;Yin X;Sheng L;Xu S;Dong L;Liu L
为了阐明新辅助化疗（NAC）对可手术胃癌患者生存结局的影响，我们检索了PubMed、Embase和科克伦图书馆中截至2014年6月发表的随机临床试验，这些试验比较了在胃或食管胃交界处腺癌患者中使用含NAC策略与不使用NAC策略的效果，这些患者接受了潜在的根治性切除术。亚组分析显示，联合使用NAC的治疗组的总生存率（OS）显著高于单纯使用AC的对照组（HR = 0.48，95%CI：0.35-0.67; P < 0.001）。而NAC单独加手术并没有显示出比单独手术有任何生存益处。与单纯手术相比，围手术期化疗（PC）也显示PFS显著增加，远处转移显著减少。因此，在可切除的胃癌患者中，单用NAC是不够的，单用AC也不足以明确改善其OS。总的来说，PC联合手术可以最大限度地提高可切除胃癌患者的生存获益。
To clarify the effect of neoadjuvant chemotherapy (NAC) on the survival outcomes of operable gastric cancers, we searched PubMed, Embase, and Cochrane Library for randomized clinical trials published until June 2014 that compared NAC-containing strategies with NAC-free strategies in patients with adenocarcinoma of the stomach or the esophagogastric junction, who had undergone potentially curative resection. The adjusted pooled hazard ratio (HR) for overall survival (OS) was insignificant when comparing the NAC-containing arm with the NAC-free arm. Subgroup analysis showed that the OS of the treatment arm that involved both adjuvant chemotherapy (AC) and NAC was significantly improved over the control arm (AC only) (HR = 0.48, 95% CI: 0.35–0.67; P < 0.001). While NAC alone plus surgery did not show any survival benefit over surgery alone. Perioperative chemotherapy (PC) also showed a significant increase in PFS and a significant reduction in distant metastasis compared to surgery alone. Therefore, in patients with resectable gastric cancer, NAC alone is not enough and AC alone is not good enough to definitely improve their OS. Collectively, PC combined with surgery could maximize the survival benefit for patients with resectable gastric cancer.