Meta-Analysis
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World J Gastroenterol. Jan 14, 2014; 20(2): 584-592
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.584
Chemotherapy for patients with gastric cancer after complete resection: A network meta-analysis
Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang
Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
Author contributions: Zhang YW, Zhang YL and Zhang YC designed the research; Wei FX, Han W and Wang ZY performed the research; Pan H, Shao Y, Liu HP and Yang SH analyzed the data; Zhang YW, Zhang YL and Zhang YC wrote the paper.
Correspondence to: Dr. You-Cheng Zhang, Department of General Surgery, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu Province, China. zhangychmd@126.com
Telephone: +86-931-8942287 Fax: +86-931-8942287
Received: July 22, 2013
Revised: October 26, 2013
Accepted: November 1, 2013
Published online: January 14, 2014
Abstract

AIM: To conduct a network meta-analysis to evaluate the effectiveness of different chemotherapy regimens for patients with gastric cancer.

METHODS: PubMed (1966-2011.12), the Cochrane Library (2011 Issue 2) and EMBASE (1974-2011.12) were searched with the terms “gastric cancer” and “chemotherapy”, as well as the medical subject headings. References from relevant articles and conferences were also included. Patients who had previous gastric surgery, radiation before or after surgery or chemotherapy before surgery were excluded. In this study, only randomized controlled trials (RCTs) were considered, and the end-point was the overall mortality. Direct comparisons were performed using traditional meta-analysis whereas indirect comparisons were performed using network meta-analysis.

RESULTS: In total, 31 RCTs with 7120 patients were included. Five chemotherapy regimens, fluorouracil (FU) + BCNU, FU + methyl-CCNU (mCCNU), FU + cisplatin, FU + anthracyclines and FU + mitomycin c (MMC) + cytarabine (Ara-c), were found to be less beneficial in terms of overall mortality. In contrast, four chemotherapy regimens were effective for the patients after surgery, including FU + MMC + adriamycin (FMA), FU + MMC (FM), Tegafur and MMC, There was no significant difference in terms of overall mortality among these regimens. The evidence for the FM regimen and MMC regimen was poor. Additionally, the FMA regimen, which includes a variety of chemotherapy drugs and causes many side effects, was not better than the Tegafur regimen.

CONCLUSION: Although the four chemotherapy regimens were effective in patients with gastric cancer after surgery and the overall mortality revealed no significant difference among them in the network meta-analysis, thorough analysis of the results recommends Tegafur as the first-line adjuvant chemotherapy regimen for patients after complete resection.

Keywords: Gastric cancer, Chemotherapy, Randomized controlled trials, Indirect treatment comparison, Network meta-analysis

Core tip: Although adjuvant chemotherapy after complete resection of gastric cancer is therapeutically useful, which of the many regimens is most effective? To date, no regimen has been clearly recommended as the standard procedure post-operation; therefore, we performed a network meta-analysis, which is a useful tool to summarize the different clinical trials and to evaluate the effectiveness of different chemotherapy regimens for patients after complete resection of gastric cancer. Based on our findings, the Tegafur regimen, especially S-1, is the first therapy that should be recommend to the patients to reduce overall mortality.