Multimodal treatments for resectable gastric cancer: A systematic review and network meta-analysis |
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| Affiliation: | 1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China;2. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA;1. Department of Urology & Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Urologic Oncology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA;3. Division of Biostatistics, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA;4. Division of Pathology, Fox Chase Cancer Center-Temple Health System, Philadelphia, PA;1. Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;3. Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;7. Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;4. Infectious Disease Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland;6. Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Sibley Memorial Hospital, Washington, District of Columbia;5. Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Surgery, Institut Paoli-Calmettes, Marseille, France;2. Department of Oncology, Institut Paoli-Calmettes, Marseille, France;3. Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France;4. Department of Pathology, Institut Paoli-Calmettes, Marseille, France;5. Department of Endoscopy, Institut Paoli-Calmettes, Marseille, France;6. Aix-Marseille University, Institut Paoli-Calmettes, Department of Surgery, CNRS, Inserm, CRCM, Marseille, France;1. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan;1. Department of Pathology and Laboratory Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States;2. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States;3. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States |
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| Abstract: | Different countries prefer particular types of multimodal treatments against resectable gastric cancer. Due to lacking of unified conclusions, we therefore conducted a network meta-analysis to rank all recommended strategies simultaneously and hierarchically. Record retrieval was conducted in PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, ASCO and ESMO meeting libraries from inception to September 2018. Randomized controlled trials featuring comparisons between different preferred multimodal treatments against resectable gastric cancer were eligible. The Cochrane Risk of Bias Tool was applied to assess methodological quality of included trials. Overall survival was primary endpoint. Network calculation was based on random-effects model and the relative ranking of each node was numerically indicated by P-score. All procedures were conducted according to Cochrane Handbook 5.1 and PRISMA for Network Meta-analysis (CRD42018109147). As a result, a total of 11 studies were included into our systematic review, corresponding to 7235 patients. Regarding overall survival, “PeriCT (FLOT)” (perioperative 5-FU plus leucovorin plus oxaliplatin plus docetaxel chemotherapy) topped the hierarchy (HR 1.00, P-score = 0.918), followed by “PostCT (XP)” (postoperative capecitabine plus platinum chemotherapy; HR 1.14, P-score = 0.759) and “PostCT (S-1)” (postoperative S-1 monotherapy; HR 1.16, P-score = 0.732). In subgroup analyses, “PostCT (XP)” became the top regimen for eastern population while “PeriCT (FLOT)” was the optimal node for western population. In conclusion, perioperative FLOT chemotherapy could potentially be the best multimodal treatment against resectable gastric cancer than other recommended strategies. Therefore, a global D2-lymphadenectomy randomized controlled trial comparing perioperative FLOT chemotherapy with postoperative XELOX chemotherapy should be carried out. |
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| Keywords: | Multimodal treatments Resectable gastric cancer Perioperative chemotherapy Postoperative chemotherapy Systematic review Network meta-analysis |
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