Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: A meta-analysis of published randomised trials: A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente)

Background: Several studies have investigated the possible roleof the adjuvant chemotherapy after curative resection for gastriccancer failing to show a clear indication; previous meta-analysessuggested small survival benefit of adjuvant chemotherapy, butthe statistical methods used were open to criticisms. Materials and methods: Randomised trials were identified bymeans of Medline and CancerLit and by selecting references fromrelevant articles. Systematic review of all randomised clinicaltrials of adjuvant chemotherapy for gastric cancer comparedwith surgery alone, published before January 2000, were considered.Pooling of data was performed using the fixed effect model.Death for any cause was the study endpoint. The hazard ratioand its 95% confidence intervals (95% CI), derived accordingto the method of Parmar, were the statistics chosen for summarisingthe relative benefit of chemotherapy versus control. Results: Overall 20 articles (21 comparisons) were consideredfor analysis. Three studies used single agent chemotherapy,seven combination of 5-fluorouracil (5-FU) with anthracyclin,ten combination of 5-FU without anthracyclines. Informationon 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio0.82, 95% CI: 0.75–0.89, P < 0.001). Association ofAnthracyclines to 5-FU did not show a statistically significantimprovement when compared with the effect of the other regimens. Conclusions: Chemotherapy produces a small survival benefitin patients with curatively resected gastric cancer. However,taking into account the limitations of literature based meta-analyses,adjuvant chemotherapy is still to be considered as an investigationalapproach. adjuvant, chemotherapy, gastric cancer, meta-analysis, randomised clinical trial