Letters To The Editor
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World J Gastroenterol. Oct 28, 2011; 17(40): 4542-4544
Published online Oct 28, 2011. doi: 10.3748/wjg.v17.i40.4542
Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer
Xin-Zu Chen, Kun Yang, Jie Liu, Xiao-Long Chen, Jian-Kun Hu
Xin-Zu Chen, Kun Yang, Jie Liu, Jian-Kun Hu, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Long Chen, Faculty of Medicine, West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen XZ designed this research and wrote the paper; Yang K, Liu J and Chen XL performed research; Hu JK is responsible for the academic inspection.
Correspondence to: Jian-Kun Hu, MD, PhD, Professor, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Xiang Street, Chengdu 610041, Sichuan Province, China. hujkwch@126.com
Telephone: +86-28-85422878 Fax: +86-28-85164035
Received: February 24, 2011
Revised: April 3, 2011
Accepted: April 10, 2011
Published online: October 28, 2011
Abstract

Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.

Keywords: Gastric cancer, Adjuvant chemotherapy, Neoadjuvant chemotherapy, Surgery, Survival