Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis |
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| Affiliation: | 1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China;2. Department of Clinical Medicine of year 2017, Dalian Medical University, PR China;1. Kaplan Medical Center, Dept of Surgery and Breast Health Center, Rehovot, Israel;2. Hadassah Hebrew University Medical School, Jerusalem, Israel;3. Tel Aviv Sourasky Medical Center, Dept of Surgery, Israel;4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;5. Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel;6. Kaplan Medical Center, Dept of Radiology and Breast Health Center, Rehovot, Israel;7. Kaplan Medical Center, Dept of Pathology, Rehovot, Israel;8. Rabin Medical Center- Beilinson, Dept of Surgery, Petach Tikva, Israel;9. Tel Aviv Sourasky Medical Center, Dept of Radiology, Tel Aviv, Israel;10. Rabin Medical Center- Hasharon, Dept of Surgery, Petach Tikva, Israel;1. Department of Breast Surgery, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK;2. Universiti Teknologi MARA (UiTM), Malaysia;3. Department of Pathology, Guy''s and St Thomas'' NHS Foundation Trust, London, UK;4. Department of Radiology, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK;1. Department of Otolaryngology - Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Republic of Korea;2. Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea;3. Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea;1. Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan;2. Division of Surgery, Keio University School of Medicine, Tokyo, Japan;3. Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan;4. Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan;5. SRL, Inc., Tokyo, Japan;6. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan;7. Shizuoka Cancer Center, Shizuoka, Japan;1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia;2. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia;3. RPA Institute of Academic Surgery (IAS), Sydney, Australia;4. The University of Sydney, New South Wales, Australia |
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| Abstract: | BackgroundAdjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients.MethodsPubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I2 statistic and publication bias was detected using standard error-based funnel plots.ResultsA total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03–1.08, P < 0.001; I2 = 18.5%) and DFS (HR:1.06, 95% CI: 1.02–1.10, P = 0.001; I2 = 40.6%).ConclusionThe initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely. |
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| Keywords: | Gastric cancer Adjuvant chemotherapy Time to initiation Delay Survival |
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