Federico Coccolini1, Matteo Nardi2, Giulia Montori3, Marco Ceresoli3, Andrea Celotti4, Stefano Cascinu5, Paola Fugazzola3, Matteo Tomasoni3, Olivier Glehen6, Fausto Catena7, Yutaka Yonemura8, Luca Ansaloni9. 1. General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: federico.coccolini@gmail.com. 2. General Surgery Dept., La Sapienza University Hospital, Roma, Italy. 3. General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy. 4. Second Surgical Dept., Civili Hospital, Brescia, Italy. 5. Medical Oncology Dept., University Hospital, Modena, Italy. 6. General Surgery Dept., Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France. 7. General Surgery Dept., Ospedale Maggiore, Parma, Italy. 8. General Surgery Dept., Kusatsu General Hospital, Yabase 1660, Japan. 9. General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy.
Abstract
INTRODUCTION: Even in after curative surgery and adequate linfoadenectomy the survival of advanced gastric cancer (AGC) remains poor. At present some data have been published on the effects of NACT and perioperative chemotherapy on AGC and Esophago-gastric cancer (EGC) but not definitive ones. The present meta-analysis aims to evaluate the effects of neoadjuvant chemotherapy (NACT) on the AGC and EGC. MATERIAL AND METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) of NACT + surgery vs. Surgery in patients with AGC and EGC was performed. RESULTS: 15 RCTs have been included (2001 patients: 977 into NACT + surgery arm and 1024 into control arm). NACT + Surgery reduces the overall mortality at 1, 3 and 5-year in cumulative analysis (RR = 0.78; 0.81; 0.88 respectively), at 1, 2, 3 and 5-years in EGC (RR = 0.79; 0.83; 0.84; 0.91 respectively) and at 3 and 5-years in AGC (RR = 0.74; 0.82 respectively). Morbidity and perioperative mortality rate are not influenced by NACT. Recurrence rate is reduced by NACT + surgery in EGC (RR = 0.80). CONCLUSIONS: NACT reduces the mortality in gastric and esophago-gastric cancer. Morbidity and perioperative mortality are not influenced by NACT. The overall recurrence rate is reduced by NACT in esophago-gastric cancer.
INTRODUCTION: Even in after curative surgery and adequate linfoadenectomy the survival of advanced gastric cancer (AGC) remains poor. At present some data have been published on the effects of NACT and perioperative chemotherapy on AGC and Esophago-gastric cancer (EGC) but not definitive ones. The present meta-analysis aims to evaluate the effects of neoadjuvant chemotherapy (NACT) on the AGC and EGC. MATERIAL AND METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) of NACT + surgery vs. Surgery in patients with AGC and EGC was performed. RESULTS: 15 RCTs have been included (2001 patients: 977 into NACT + surgery arm and 1024 into control arm). NACT + Surgery reduces the overall mortality at 1, 3 and 5-year in cumulative analysis (RR = 0.78; 0.81; 0.88 respectively), at 1, 2, 3 and 5-years in EGC (RR = 0.79; 0.83; 0.84; 0.91 respectively) and at 3 and 5-years in AGC (RR = 0.74; 0.82 respectively). Morbidity and perioperative mortality rate are not influenced by NACT. Recurrence rate is reduced by NACT + surgery in EGC (RR = 0.80). CONCLUSIONS:NACT reduces the mortality in gastric and esophago-gastric cancer. Morbidity and perioperative mortality are not influenced by NACT. The overall recurrence rate is reduced by NACT in esophago-gastric cancer.
Authors: Masaya Nakauchi; Elvira Vos; Laura H Tang; Mithat Gonen; Yelena Y Janjigian; Geoffrey Y Ku; David H Ilson; Steven B Maron; Sam S Yoon; Murray F Brennan; Daniel G Coit; Vivian E Strong Journal: Ann Surg Oncol Date: 2021-02-10 Impact factor: 4.339