Brief Article
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World J Gastroenterol. Nov 28, 2010; 16(44): 5621-5628
Published online Nov 28, 2010. doi: 10.3748/wjg.v16.i44.5621
Neoadjuvant chemotherapy for advanced gastric cancer: A meta-analysis
Wei Li, Jing Qin, Yi-Hong Sun, Tian-Shu Liu
Wei Li, Tian-Shu Liu, Department of Medical Oncology, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jing Qin, Yi-Hong Sun, Department of General Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Li W and Qin J contributed equally to this work; Liu TS, Qin J and Sun YH designed the research; Li W and Liu TS performed the research and analyzed the data; Liu TS, Qin J and Li W wrote the paper; Sun YH and Qin J supervised the whole study.
Correspondence to: Tian-Shu Liu, MD, Department of Medical Oncology, Shanghai Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032, China. tsliuceu@gmail.com
Telephone: +86-21-64041990 Fax: +86-21-52303355
Received: June 22, 2010
Revised: August 30, 2010
Accepted: September 7, 2010
Published online: November 28, 2010
Abstract

AIM: To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.

METHODS: All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched. Studies that included patients with metastases at enrollment were excluded. Databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, and American Society of Clinical Oncology meeting abstracts from 1978 to 2010. The censor date was up to April 2010. Primary outcome was the odds ratio (OR) for improving overall survival rate of patients with advanced gastric cancer. Secondary outcome was the OR for down-staging tumor and increasing R0 resection in patients with advanced gastric cancer. Safety analyses were also performed. All calculations and statistical tests were performed using RevMan 5.0 software.

RESULTS: A total of 2271 patients with advanced gastric cancer enrolled in 14 trials were divided into NAC group (n = 1054) and control group (n = 1217). The patients were followed up for a median time of 54 mo. NAC significantly improved the survival rate [OR = 1.27, 95% confidence interval (CI): 1.04-1.55], tumor stage (OR = 1.71, 95% CI: 1.26-2.33) and R0 resection rate (OR = 1.51, 95% CI: 1.19-1.91) of patients with advanced gastric cancer. No obvious safety concerns were raised in these trials.

CONCLUSION: NAC can improve tumor stage and survival rate of patients with advanced gastric cancer with a rather good safety.

Keywords: Gastric cancer, Neoadjuvant chemotherapy, Survival, Meta-analysis