Gastric exclusion for unresectable gastric cancer.

BACKGROUND/AIMS: Conventional gastrojejunostomy is sometimes performed for unresectable gastric cancer, but it is not fully effective. To improve the patient's quality of life, we performed gastric exclusion. METHODOLOGY: Twenty-seven patients who received gastrojejunostomy (11 conventional, 16 gastric exclusion) were retrospectively examined as to post-operative quality of life and outcome. RESULTS: No stomal strictures were observed, and gastrointestinal bleeding was significantly reduced in the gastric exclusion group. These advantages enabled the gastric exclusion group to achieve better quality of life, as indicated by longer oral intake (244 days vs. 98 days) and home stay (211 days vs. 91 days). The prognosis also improved. The 50% survival period in the gastric exclusion group was 229 days, whereas, that of the conventional gastrojejunostomy group was 131 days. CONCLUSIONS: The quality of life and prognosis of the gastric exclusion group significantly improved, and we believe that the improvement of the quality of life yielded a better prognosis. We recommend gastric exclusion as a standard procedure for unresectable gastric cancer.     

Low-dose cisplatin plus oral tegafur and uracil for the treatment of lung metastases of hepatocellular carcinoma

BACKGROUND/AIMS: An effective treatment for unresectable multiple lung metastases of hepatocellular carcinoma have never been established. METHODOLOGY: Six patients received the chemotherapy described herein as an initial treatment for lung metastases of hepatocellular carcinoma. Low-dose cisplatin infusion plus oral tegafur and uracil administration combination therapy essentially consisted of cisplatin (10 mg/day over 1 hour) infused on days 1-5 every week and oral tegafur and uracil (300 mg/day) administrated every day. This treatment was repeated weekly for essentially 4 consecutive weeks. RESULTS: Complete response was observed in no cases and partial response in 3 cases, while no change was observed in 4 cases and progressive disease in one case. An overall response rate was 50%. The serum alpha-fetoprotein and des-Y-carboxyprothrombin were reduced in most of the patients. Leukopenia of grade 2 was observed in only 1 (17%) patient. Thrombocytopenia of grade 2 was observed in 2 (33%) patients. Nausea (up to Grade 2) was occurring in 4 (67%) patients. Three patients with no other distant metastasis survive more than two years after lung metastasis, and the quality of life of these patients are well preserved. CONCLUSIONS: Low-dose cisplatin infusion combined with oral tegafur and uracil administration for the treatment of lung metastases of hepatocellular carcinoma may be an effective regimen with a high response rate and acceptable toxicities, although a larger study will be necessary to confirm the efficacy.     

体外香菇多糖对顺铂抑制胃癌细胞增殖的促进作用

目的:研究体外香菇多糖(Lentinan)对多药耐药基因表达的影响和促进顺铂抑制胃癌细胞增殖的作用.方法:分别用顺铂(Cisplatin)、香菇多糖和顺铂联合香菇多糖处理SGC-7901胃癌细胞,将其分为4组:对照组(Con组),香菇多糖组(Len组),顺铂组(Cis组)和顺铂联合香菇多糖组(L+C)组.应用RT-PCR检测多药耐药基因MDR1、MRP1和LRP基因mRNA表达;应用CCK-8试剂盒检测Con组和药物处理组前后的胃癌细胞增殖状态.结果:正常SGC-7901胃癌细胞中多药耐药基因MDR1、MRP1和LRP均表达mRNA,香菇多糖能显著降低多药耐药基因表达而对细胞增殖无明显影响;顺铂明显增加多药耐药基因表达,同时抑制细胞增殖(P<0.05);香菇多糖联合顺铂作用后,MDR1和MRP1基因表达完全受到抑制,LRP表达显著降低,细胞增殖速度明显低于Con组、Len组和Cis组,差异具有统计学意义(10d:0.54vs1.90,1.88,0.92,均P<0.05).结论:香菇多糖联合顺铂后因抑制多药耐药基因表达而显著增强顺铂的抑制细胞增殖作用.     

香菇多糖增强DCF方案治疗晚期胃癌40例

目的:探讨香菇多糖对DCF方案（多西他赛,顺铂和5-氟尿嘧啶）治疗晚期胃癌疗效的影响.方法:将2007-01/2008-12诊治的80例Ⅲ-Ⅳ期晚期胃癌患者随机分成2组,分别给予DCF方案(DCF组)和香菇多糖联合DCF方案(Len+DCF组)治疗,分析2组患者的疗效、血常规、淋巴细胞亚群和生存质量差异.结果:DCF组...     

The role of sandostatin LAR in treating patients with advanced hepatocellular cancer

BACKGROUND/AIMS: The overexpression of somatostatin receptors in the liver of some patients with hepatocellular carcinoma is well documented. The daily administration of octreotide in patients with advanced hepatocellular carcinoma was shown to have a marginal clinical effectiveness. The aim of the study was to estimate if and to what extent the administration of octreotide long-acting formulation (Sandostatin LAR) improves survival and quality of life in patients with advanced unresectable hepatocellular carcinoma. METHODOLOGY: Twenty-eight cirrhotic patients (stages A-B) with advanced hepatocellular carcinoma were enrolled in the study. Octreoscan scintigraphy for detection of STTR was performed in all cases. If it showed intense uptake in the liver, octreotide was administered as follows: Sandostatin 0.5 mg subcutaneous every 8 hours for 6 weeks. At the end of weeks 4-8 Sandostatin LAR 20 mg and at the end of week 12 and every 4 weeks Sandostatin LAR 30 mg intramuscularly. Patients' follow-up was worked out monthly. Thirteen patients unable to receive treatment were used as control group. RESULTS: Comparison of results between the 2 groups showed a significant difference in the median survival time (31 vs. 16 weeks, p = 0.037) and an improvement of quality of life (60% vs. 23.07%). Also, treated group showed a 72% reduction in the risk of dying during the follow-up period (p = 0.002). No alpha-fetoprotein reduction and decrease of the tumor mass was observed. CONCLUSIONS: In conclusion, the administration of Sandostatin LAR it appears to improve the survival and the quality of life in patients with advanced hepatocellular carcinoma.     

Lentinan combined with cisplatin for the treatment of non-small cell lung cancer

Background:A growing number of studies suggest that lentinan combined with cisplatin thoracic injection for the treatment of lung cancer is an effective combination of traditional Chinese and Western medicine, which has a continuous and beneficial effect on eliminating clinical symptoms and improving cachexia in lung cancer patients. However, whether this treatment is effective and safe for lung cancer patients or not, evidence supporting the effectiveness and safety of this treatment is still incomplete. Besides, there is lack of systematic review to assess the detailed situation (including risk of bias and methodology) of current related clinical studies.Objective:This study aimed to evaluate the effectiveness and safety of lentinan combined with cisplatin thoracic injection in the treatment of lung cancer.Methods:The major databases (Embase, PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database [VIP] Database, Chinese Biomedical Literature Service System [SinoMed], and Wanfang Database) were searched from inception to March 1, 2020. Randomized controlled trials (RCTs) of lentinan combined with cisplatin chest injection on patients with non-small cell lung cancer (NSCLC) were identified. Two assessors reviewed each trial independently. The methodological quality of the eligible studies was evaluated according to the Cochrane Collaboration''s tool for assessing risk of bias. Both the data extraction and the literature quality screening evaluation were conducted independently by 2 researchers.Results:Totally 17 clinical RCTs were included in this study, involving 1390 patients. Meta-analysis results showed that the clinical efficacy (risk ratio [RR] = 1.34, 95% confidence interval [CI] 1.21–1.48), effective subgroup analysis (RR = 1.51, 95% CI 1.3–1.77), and quality of life (RR = 1.48, 95% CI 1.27–1.72), the differences are statistically significant. In terms of adverse reactions, mainly related to gastrointestinal reactions and bone marrow suppression, the incidence and degree of adverse reactions of lentinan combined with cisplatin thoracic injection group were lower than those of cisplatin thoracic injection group alone.Conclusions:The current evidence prompted that Lentinan combined with cisplatin in thoracic injection might benefit patients with NSCLC on a certain extent; this systematic review revealed some definite conclusions about the application of Lentinan combined with cisplatin in thoracic injection for NSCLC. Due to the low methodological quality, high risk of bias, and inadequate reporting on clinical data, these results still require verification by a large number of well designed, heterogeneous RCT studies. More rigorous, multicenter, sufficient-sample, and double-blind RCTs are warranted.     

Improved survival with oral administration of enteric-coated tegafur/uracil for advanced stage IV-A hepatocellular carcinoma

BACKGROUND AND AIMS: There is currently no proven chemotherapy regimen for hepatocellular carcinoma (HCC). The principal chemotherapeutic approach in most cases is infusion therapy into the hepatic arteries feeding the tumors. However, the clinical effects of chemotherapy are extremely poor. Therefore, in the present study, we conducted a prospective randomized trial of the efficacy of oral administration of enteric-coated tegafur/uracil for advanced HCC. METHODS: From 1994 to 1999, a total of 56 consecutive patients with unresectable stage IV-A HCC were studied prospectively to examine the efficacy of enteric-coated tegafur/uracil in HCC and to determine the significant prognostic factors. Twenty-eight patients were treated only with enteric-coated tegafur/uracil without other anticancer treatment. Another 20 patients were given conservative management only. The remaining eight patients withdrew from the study. RESULTS: In the group treated only with enteric-coated tegafur/uracil, the median survival time and 1 and 2 year survival rates were 12.13 months and 55.3 and 36.9%, respectively. In the control group, the median survival time and 1 year survival rate were 6.20 months and 5.5%, respectively. By both univariate analysis and multivariate analysis using Cox's proportional hazards model, treatment with enteric-coated tegafur/uracil was shown to be the factor most significantly favoring a better prognosis. CONCLUSIONS: Although the prognosis of most patients with stage IV-A HCC is poor, administration of enteric-coated tegafur/uracil induces long-term survival and is an effective treatment for stage IV-A HCC.     

顺铂联合香菇多糖胸腔内注射对老年肺癌伴胸腔积液的疗效分析

目的 观察顺铂联合香菇多糖胸腔内注射对老年肺癌伴胸腔积液的疗效.方法 选择老年肺癌性胸腔积液患者80例,随机分成观察组（顺铂联合香菇多糖）和对照组（顺铂）各40例.在经皮胸腔内置管引流尽胸液之后,进行胸腔内注药,观察疗效.结果 观察组和对照组的总有效率分别为92.50%和62.50%,生活质量改善率分别为87.50%和65.00%,P〈0.05.结论 顺铂联合香菇多糖胸腔内注射对老年肺癌伴胸腔积液具有较好疗效,不良反应少.     

Clinical efficacy of intra-arterial pharmacokinetic chemotherapy with 5-fluorouracil, CDDP, gemcitabine, and angiotensin-II in patients with advanced pancreatic cancer

BACKGROUND/AIMS: To deliver anticancer drugs more selectively into cancer tissues and to improve survival time, we have developed a new method of intra-arterial chemotherapy for unresectable pancreatic cancer. METHODOLOGY: From April 2002 to June 2006, twenty patients with pancreatic cancer with liver metastases were given intra-arterial infusions consisting of gemcitabine, 5-FU, and cisplatin mixed with angiotensin-II with the intent of increasing the blood flow into the tumor tissue but decreasing that to the non-tumor tissues. Simultaneously, tegafur/uracil was administered. A tumor marker and computed tomography (CT) findings were used to evaluate the efficacy of this chemotherapy. RESULTS: The median survival was 365 days, and 6-months and 1-year survival rates were 80.0% and 44.7%, respectively. In 12 of 20 cases, the tumor marker level was decreased after this chemotherapy. In 10 of 20 cases, computed tomography showed a decrease in the tumor size. In 6 patients, back pain was the chief complaint and was reduced to a self-controlled level in 20 patients. No major complications were encountered. CONCLUSIONS: Compared with the previously reported data in traditional chemotherapies, our method of intra-arterial chemotherapy appears to be quite useful not only for prolonging patient survival but also for improving the quality of life. Intra-arterial regional chemotherapy including changes in distribution of blood flow induced by angiotensin-II appears to be an effective palliative treatment for advanced pancreatic cancer.     

A new chemotherapeutic regimen for advanced unresectable hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study was to evaluate the efficacy and toxicity of a novel chemotherapeutic regimen for advanced unresectable hepatocellular carcinoma. METHODOLOGY: Seventeen patients with unresectable hepatocellular carcinoma were treated by arterial infusion once a week of low-dose cisplatin (12 mg/m2) and doxorubicin (6 mg/m2) via a subcutaneously implanted injection port and by daily oral administration of 300 mg/day of UFT comprising 5-fluorouracil prodrug tegafur (FT) and uracil (U) at a ratio of 1:4. RESULTS: The median number of chemotherapy courses was 13 (range, 5-33). All patients were evaluated for response, toxicity, and survival. As assessed by conventional imaging criteria, there were 3 (17.6%) complete responses with disappearance of the primary tumor, tumor thrombosis of the portal vein and metastatic para-aortic lymph node swelling. In addition, there were 4 (23.5%) partial responses. Among 11 patients who had initially high alpha-fetoprotein levels (> 200 ng/mL), 5 (45%) had a > 50% drop after therapy. The overall tumor response rate (complete response + partial response) was 41% and the median survival was 7.1 (range; 4.2-25.1) months. As for toxicity, there was 1 treatment-related death due to septicemia caused by catheter-related infection. Myelosuppression and renal toxicity was relatively mild and transient. CONCLUSIONS: These results suggest that our low-dose chemotherapeutic regimen may be useful for the treatment of advanced unresectable hepatocellular carcinoma without worsening the quality of life of the patient.     

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.     

香菇多糖抗衰老作用的实验研究

采用寿命短、繁殖能力强的家蝇为衰老实验动物模型,观察香菇多糖对家蝇寿命及脑内SOD活性和脂褐素含量的影响。实验结果显示,香菇多糖能提高SOD活性和降低脂褐素含量。20日龄时喂香菇多糖组蝇脑内SOD活性比对照组增加43.4％,脂褐素含量下降4.9％;实验组平均寿命比对照组延长19.4％。提示香菇多糖可能具有抗衰老及保健作用。     

The addition of induction chemotherapy with etoposide, ifosfamide, and cisplatin failed to improve therapeutic outcome of concurrent chemoradiotherapy in patients with locally advanced non-small cell lung cancer -- single institution retrospective analysis

Although chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC), the optimal sequencing remains to be determined. We retrospectively compared the treatment results of induction chemotherapy followed by concurrent CRT (induction group, 32 patients) with those of concurrent CRT alone (concurrent group, 41 patients) in unresectable stage IIIA/IIIB NSCLC patients. In induction group, 2 cycles of induction chemotherapy (etoposide/ifosfamide/cisplatin: 24 patients, others: 8 patients) were followed by concurrent CRT (60 Gy/30 fractions, 6 mg/m2 of cisplatin daily), while the same concurrent CRT was administered in concurrent group. Clinicopathologic characteristics including age, weight loss, histologic types, and clinical stage did not show significant differences between two groups except for a higher proportion of patients with ECOG performance status 2 in concurrent group (3% vs. 27%, p=0.015). Overall toxicity was generally acceptable with 1 treatment-related death from tracheoesophageal fistula in induction group. The response rates after concurrent CRT were 41% for induction group and 54% for concurrent group, which showed no significant difference (p=0.560). With median follow-up of 13 (1-92) months, there was a trend toward an advantage for concurrent group in median progression-free survival (6 months vs 8.3 months, p=0.067) and overall survival (12 months vs. 14.5 months, p=0.059). In multivariate analysis, only more than 10% weight loss within 6 months was significantly associated with poor survival (p=0.001). In conclusion, the addition of induction chemotherapy to concurrent CRT did not show any advantage over concurrent CRT alone in locally advanced NSCLC.     

Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis

Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.     

胸腔穿刺置管引流联合顺铂腔内注射治疗恶性胸腔积液

目的 探讨胸腔穿刺置管引流联合顺铂腔内注射治疗恶性胸腔积液的疗效及机制.方法 46例恶性胸腔积液患者分为观察组(23例)和对照组(23例),观察组患者放尽胸水后注入顺铂进行治疗,对照组患者单纯胸腔置管引流治疗.结果 观察组有效率(78.26％)高于对照组(56.52％),差异有统计学意义(P＜0.05),生活质量提高(P＜0.05).结论 胸腔置管引流联合顺铂腔内注射治疗恶性胸腔积液疗效显著.     

Stomach-interposed cholecystogastrojejunostomy： A palliative approach for periampullary carcinoma

AIM: For patients of periampullary carcinoma found to be unresectable at the time of laparotomy, surgical palliation is the primary choice of treatment. Satisfactory palliation to maximize the quality of life with low morbidity and mortality is the gold standard for a good procedure. Our aim is to explore such a procedure as an alternative to the traditional ones. METHODS: A modified double-bypass procedure is performed by, in addition to the usual gastrojejunostomy, implanting a mushroom catheter from the gall bladder into the jejunum through the interposed stomach as an internal drainage. A retrospective review was performed including 22 patients with incurable periampullary carcinomas who underwent this surgery. RESULTS: Both jaundice and impaired liver function improved significantly after surgery. No postoperative deaths, cholangitis, gastrojejunal, biliary anastomotic leaks, recurrent jaundice or late gastric outlet obstruction occurred. Delayed gastric emptying occurred in two patients. The total surgical time was 150±26 min. The estimated blood loss was 160±25 ml. The mean length of hospital stay after surgery was 22±6 d. The mean survival was 8 mo (range 1.5-18 mo). CONCLUSION: In patients of unresectable periampullary malignancies, stomach-interposed cholecystogastr-ojejunostomy is a safe, simple and efficient technique for palliation.     

elderly patients with unresectable pancreatic headcancer

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree ( P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A ( P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.     

胸腔内注射顺铂及香菇多糖治疗老年恶性胸腔积液的临床观察

目的观察胸腔内置管注入顺铂和香菇多糖治疗老年恶性胸腔积液的疗效。方法老年恶性胸腔积液68例,随机分为两组,治疗组经皮胸腔内置管引流尽胸液后,胸腔内注入顺铂和香菇多糖,对照组予顺铂注入胸腔。每周复查胸水情况,观察疗效及不良反应。结果治疗组总有效率为73.5%,高于对照组52.9%,差异有统计学意义（P〈0.05）。两组均有发热、恶心、呕吐、外周血白细胞减少等不良反应,但差异无统计学意义。结论胸腔内注入顺铂和香菇多糖治疗老年恶性胸腔积液疗效好且安全。     

Guidelines for chemotherapy of biliary tract and ampullary carcinomas

Few randomized controlled trials (RCTs) with large numbers of patients have been conducted to date in patients with biliary tract cancer, and standard chemotherapy has not been established yet. In this article we review previous studies and clinical trials regarding chemotherapy for unresectable biliary tract cancer, and we present guidelines for the appropriate use of chemotherapy in patients with biliary tract cancer. According to an RCT comparing chemotherapy and best supportive care for these patients, survival was significantly longer and quality of life was significantly better in the chemotherapy group than in the control group. Thus, chemotherapy for patients with biliary tract cancer seems to be a significant treatment of choice. However, chemotherapy for patients with biliary tract cancer should be indicated for those with unresectable, locally advanced disease or distant metastasis, or for those with recurrence after resection. That is why making the diagnosis of unresectable disease should be done with greatest care. As a rule, pathological diagnosis, including cytology or histopathological diagnosis, is preferable. Chemotherapy is recommended in patients with a good general condition, because in patients with general deterioration, such as those with a performance status of 2 or 3 or those with insufficient biliary decompression, the benefit of chemotherapy is limited. As chemotherapy for unresectable biliary tract cancer, the use of gemcitabine or tegafur/gimeracil/oteracil potassium is recommended. As postoperative adjuvant chemotherapy, no effective adjuvant therapy has been established at the present time. It is recommended that further clinical trials, especially large multi-institutional RCTs (phase III studies) using novel agents such as gemcitabine should be performed as soon as possible in order to establish a standard treatment.     

Effectiveness of 5-flurouracil-based neoadjuvant chemotherapy in locally-advanced gastric/gastroesophageal cancer: A meta-analysis

AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials(RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio(OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gas-troesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group(NAC plus surgery) vs control group(surgery alone) and was presented as a point estimate with 95% confidence intervals(CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group(n = 620) and control group(n = 629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7(5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate(OR 1.40,95%CI 1.11-1.76;P = 0.005),which was statistically significant.The 3-year progression-free survival rate was significantly higher in treatment group than in control group(37.7% vs 27.3%)(OR 1.62,95%CI 1.21-2.15;P = 0.001).The tumor down-stage rate was higher in treatment group than in control group(55.76% vs 41.38%)(OR 1.77,95%CI 1.27-2.49;P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group(75.11% vs 68.56%)(OR 1.38,95%CI 1.03-1.85;P = 0.03),with significant differences.No obvious safety concerns about mortality and complications were raised in these trials.There were no statistically significant differences in perioperative mortality(5.08% vs 4.86%)(OR 1.05,95%CI 0.57-1.94;P = 0.87 fixed-effect model) and in the complication rate between the two groups(13.25% vs 9.66%)(OR 1.40,95%CI 0.91-2.14;P = 0.12 fixed-effect model).Trials showed that patients from Western countries favored NAC compared with those from Asian countries(OR 1.40,95%CI 1.07-1.83).Monotherapy was inferior tomultiple chemotherapy(OR 1.40,95%CI 1.07-1.83).Intravenous administration of NAC was more advantageous than oral route(OR 1.41,95%CI 1.09-1.81).CONCLUSION:Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer.Additionally,NAC can down the tumor stage and improve R0 resection.