Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for locally advanced gastric cancer: a systematic review and meta-analysis

Youqi Zhu; Jiuzhou Chen; Xueqing Sun; Yufei Lou; Miao Fang; Fengjuan Zhou; Lei Zhang; Yong Xin

doi:10.3389/fonc.2023.1177557

Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for locally advanced gastric cancer: a systematic review and meta-analysis

Front Oncol. 2023 May 9:13:1177557. doi: 10.3389/fonc.2023.1177557. eCollection 2023.

Authors

Youqi Zhu^{1

2}, Jiuzhou Chen^{1

2}, Xueqing Sun^{1

2}, Yufei Lou^{1

2}, Miao Fang^{1

2}, Fengjuan Zhou³, Lei Zhang⁴, Yong Xin^{1

2}

Affiliations

¹ Department of Radiation, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
² Department of Cancer Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.
³ Department of Radiation, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
⁴ Department of Oncology, Suining County People's Hospital, Xuzhou, Jiangsu, China.

Abstract

Background: There is increasing evidence that neoadjuvant chemoradiotherapy is superior to neoadjuvant chemotherapy for patients with locally advanced gastric cancer. However, a number of studies have come to the opposite conclusion. Therefore, our meta-analysis is to evaluate the efficacy and safety of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in the treatment of locally advanced gastric cancer.

Methods: We searched Wanfang Database, China National Knowledge Network database, VIP database, China Biomedical Literature Database, PubMed, Embase and Cochrane Library. The searched terms included'Stomach Neoplasms', 'Neoadjuvant Therapy' and 'Chemoradiotherapy'. The retrieval time was from the establishment of the corresponding database to September 2022, and our meta-analysis was performed using RevMan (version 5.3) and Stata (version 17) software.

Results: A total of 17 literatures were included, which involved 7 randomized controlled trials and 10 retrospective studies, with a total of 6831 patients. The results of meta-analysis showed that compared with NACT group, the complete response rate(RR=1.95, 95%CI 1.39-2.73, p=0.0001), the partial response rate(RR=1.44, 95%CI 1.22-1.71, p=0.0001), the objective response rate(RR=1.37, 95%CI 1.27-1.54, p=0.00001), the pathologic complete response rate(RR=3.39, 95%CI 2.17-5.30, p=0.00001), the R0 resection rate(RR=1.18, 95%CI 1.09-1.29, p=0.0001) and 3-year overall survival rate(HR=0.89, 95%CI 0.82-0.96, p=0.002) of neoadjuvant chemoradiotherapy group were significantly improved. The results of subgroup analyses of gastric cancer subgroup and gastroesophageal junction cancer subgroup were consistent with the overall results. Meanwhile, the stable disease(RR=0.59, 95%CI:0.44-0.81, P=0.0010) of neoadjuvant chemoradiotherapy group was lower than that of neoadjuvant chemotherapy group, and there were no statistical significance in the progressive disease rate(RR=0.57, 95%CI:0.31-1.03, P=0.06), five-year overall survival rate(HR=1.03, 95%CI:0.99-1.07, P=0.839), postoperative complications and adverse reactions between the neoadjuvant chemoradiotherapy group and neoadjuvant chemotherapy group.

Conclusion: Compared with neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy might bring more survival benefits without significantly increasing adverse reactions. neoadjuvant chemoradiotherapy may be a recommended treatment for patients with locally advanced gastric cancer.

Systematic review registration: https://inplasy.com/inplasy-2022-12-0068/, identifier INPLASY202212068.

Keywords: gastric cancer; locally advanced gastric cancer; meta-analysis; neoadjuvant chemoradiotherapy; systematic review.

Publication types

Systematic Review

Grants and funding

This work was supported by a key program from the National Natural Science Foundation of China under Grant 81972845; Jiangsu Provincial Department of Human Resources, Social Security 14th batch of “Six Talent Peaks” high-level talent project funding project (WSN-121); Special funds for promoting scientific and technological innovation in Xuzhou in 2022 (KC22255); Postgraduate Research & Practice Innovation Program of Jiangsu Province (SJCX22_1273).