J W Liang1, Z C Zheng2, T Yu3, X Wang4, J J Zhang2. 1. Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China. Electronic address: liangjiwang1985@163.com. 2. Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China. 3. Department of Radiology, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China. 4. Center of Tumor Diagnosis and Therapy, The Second Workers Hospital of Liaohe Oil Field, Panjin, People's Republic of China.
Abstract
BACKGROUND: Adjuvant chemoradiotherapy (CRT) for patients with gastric cancer after D2 lymphadenectomy remains controversial. The objective of the present meta-analysis was to analyze efficacy and safety of postoperative CRT and establish a consensus on whether it is suitable for the patients. METHODS: We searched PubMed, Ovid, Cochrane, and Web of Science. Statistical analysis was carried out by STATA version 12.0 software. The quality of evidence was assessed by Jadad and the Newcastle-Ottawa quality assessment scale. RESULTS: Six studies involving 2135 patients were included for the meta-analysis. The results showed that, compared with non-CRT, postoperative adjuvant CRT was associated with a significant improvement in 5-year overall survival (OS) (HR = 0.79, 95% CI 0.68-0.92, P = 0.002) and 5-year relapse-free survival (RFS) (HR = 0.81, 95% CI 0.70-0.93, P = 0.004). However, there were no differences in distant metastasis (RR = 0.93, 95% CI 0.82-1.06, P = 0.304) and treatment-related toxicity between the two groups. CONCLUSIONS: From the results of our study, postoperative adjuvant CRT may be associated with longer 5-year OS and 5-year RFS in patients with D2 lymphadenectomy, but might not improve 5-year disease-free survival compared to non-CRT. Methodologically high-quality comparative studies are needed for further evaluation.
BACKGROUND: Adjuvant chemoradiotherapy (CRT) for patients with gastric cancer after D2 lymphadenectomy remains controversial. The objective of the present meta-analysis was to analyze efficacy and safety of postoperative CRT and establish a consensus on whether it is suitable for the patients. METHODS: We searched PubMed, Ovid, Cochrane, and Web of Science. Statistical analysis was carried out by STATA version 12.0 software. The quality of evidence was assessed by Jadad and the Newcastle-Ottawa quality assessment scale. RESULTS: Six studies involving 2135 patients were included for the meta-analysis. The results showed that, compared with non-CRT, postoperative adjuvant CRT was associated with a significant improvement in 5-year overall survival (OS) (HR = 0.79, 95% CI 0.68-0.92, P = 0.002) and 5-year relapse-free survival (RFS) (HR = 0.81, 95% CI 0.70-0.93, P = 0.004). However, there were no differences in distant metastasis (RR = 0.93, 95% CI 0.82-1.06, P = 0.304) and treatment-related toxicity between the two groups. CONCLUSIONS: From the results of our study, postoperative adjuvant CRT may be associated with longer 5-year OS and 5-year RFS in patients with D2 lymphadenectomy, but might not improve 5-year disease-free survival compared to non-CRT. Methodologically high-quality comparative studies are needed for further evaluation.
Authors: Yuhree Kim; Malcolm H Squires; George A Poultsides; Ryan C Fields; Sharon M Weber; Konstantinos I Votanopoulos; David A Kooby; David J Worhunsky; Linda X Jin; William G Hawkins; Alexandra W Acher; Clifford S Cho; Neil Saunders; Edward A Levine; Carl R Schmidt; Shishir K Maithel; Timothy M Pawlik Journal: Surgery Date: 2017-05-31 Impact factor: 3.982