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Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.

ABSTRACT: 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?

SUBMITTER: Yang Y

PROVIDER: S-EPMC4525358 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.

Yang Ya'nan Y Yin Xue X Sheng Lei L Sheng Lei L Xu Shan S Dong Lingling L Liu Lian L

Scientific reports 20150805

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 co ...[more]

PMID: 26242393

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Project description:BackgroundContemporary treatment of node-positive (N+) colon cancer consists of adjuvant chemotherapy; however, randomized data supporting this practice were derived from lesions T2 or greater. Minimal data exist regarding the use and need for adjuvant chemotherapy in T1N+ disease.ObjectiveThe aim of this study was to determine treatment trends and the effects of adjuvant chemotherapy on T1N+ colon cancers by using the National Cancer Database.DesignThis was a retrospective study. Baseline demographics, tumor, and cancer treatment characteristics were compared. Groups were matched on the propensity to receive chemotherapy. Adjusted long-term survival stratified by chemotherapy use was compared by using the Kaplan-Meier method with the log-rank test. Predictors of not receiving chemotherapy were identified by using a multivariable logistic regression model.SettingsData were collected from the National Cancer Database, which collects cancer data from over 1500 cancer centers.PatientsWe identified patients from 1998 to 2006 with T1N+ disease, excluding those with metastatic disease or previous cancer. Patients were stratified based on whether or not they received chemotherapy.Main outcome measuresThe primary outcome measure of this study was long-term survival.ResultsThree thousand one hundred thirty-seven patients had T1N+ disease; 70.6% (n = 2216) received chemotherapy, and utilization significantly increased from 1998 to 2011 (p < 0.001). Unadjusted analysis revealed that patients treated with chemotherapy were statistically younger and healthier, and had shorter postoperative lengths of stay (all p < 0.001). Unadjusted 5-year survival was higher in patients receiving chemotherapy (87.9% vs 63.0% in patients with no chemotherapy; p < 0.001) and this persisted after propensity matching with (83.4% and 63.0% in patients with or without chemotherapy; p < 0.001). Only age (OR, 0.29; p < 0.001) predicted not receiving chemotherapy.LimitationsLimitations include potential selection bias as well as the inability to compare disease-free survival/recurrence.ConclusionsAdjuvant chemotherapy appears to significantly improve long-term survival in patients receiving chemotherapy in T1N+ disease. Thus, the use of chemotherapy in T1N+ disease is justified and provides a highly significant survival benefit.

Project description:BackgroundPerioperative C-reactive protein (CRP) levels have effects on the prognosis of cancer patients. We intended to determine the prognostic value of combining the two for gastric cancer (GC).MethodsData were extracted from a clinical trial. By calculating the area under the curve (AUC) and the C-index, the predictive value of CRPs among different time points, including preoperative (pre-CRP), postoperative days 1, 3, and 5 (post-CRPs), and postoperative maximum CRP (post-CRPmax ), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence-free survival (RFS).ResultsFinally, 401 patients were available in the present study. For RFS, higher AUC (0.692) and concordance index (0.678) of pre-CRP were observed when compared with those of post-CRPs. Further, among post-CRPs, post-CRPmax had the highest predictive values (AUC: 0.591; concordance index: 0.585) among the other post-CRPs. The threshold values in predicting RFS for pre-CRP and post-CRPmax were 3.1 mg/L and 77.1 mg/L. Multivariate analysis showed both pre-CRP≥3.1 mg/L (high-pre-CRP) and post-CRPmax ≥77.1 mg/L (high-post-CRPmax ) were risk factors for RFS. Postoperative chemotherapy benefit was further analyzed for patients with stage II/III GC and indicated that patients with pre-CRP<3.1 mg/L had better prognosis without benefit from postoperative adjuvant chemotherapy (ACT), p = 0.557. In high-pre-CRP patients, only patients with post-CRPmax ≥77.1 mg/L but not post-CRPmax <77.1 mg/L benefited from postoperative ACT (RFS: 33.2% vs 49.9% for non-chemotherapy group and chemotherapy group, respectively, p = 0.037). Analyses for overall survival obtained the similar outcomes.ConclusionsBoth high-pre-CRP and high-post-CRPmax are associated with worse prognosis in GC. ACT seems to only improve the prognosis for stage II/III GC with pre-CRP≥3.1 mg/L and post-CRPmax ≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.

Dataset Information

Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.

Publications

Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.

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