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Survival benefit an...
Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer : A direct and adjusted indirect comparison meta-analysis
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Kumagai, K. (author)
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- Rouvelas, I. (author)
- Karolinska Institutet
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- Tsai, J. A. (author)
- Karolinska Institutet
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- Mariosa, D. (author)
- Karolinska Institutet
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- Lind, Pehr A. (author)
- Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD)
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- Lindblad, M. (author)
- Karolinska Institutet
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- Ye, W. (author)
- Karolinska Institutet
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- Lundell, L. (author)
- Karolinska Institutet
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Schuhmacher, C. (author)
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- Mauer, M. (author)
- Karolinska Institutet
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Burmeister, B. H. (author)
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Thomas, J. M. (author)
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Stahl, M. (author)
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Nilsson, M. (author)
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(creator_code:org_t)
- Elsevier BV, 2015
- 2015
- English.
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In: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 41:3, s. 282-294
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Abstract
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- Several phase I/II studies of chemoradiotherapy for gastric cancer have reported promising results, but the significance of preoperative radiotherapy in addition to chemotherapy has not been proven. In this study, a systematic literature search was performed to capture survival and postoperative morbidity and mortality data in randomised clinical studies comparing preoperative (chemo)radiotherapy or chemotherapy versus surgery alone, or preoperative chemoradiotherapy versus chemotherapy for gastric and/or gastro-oesophageal junction (GOJ) cancer. Hazard ratios (HRs) for overall mortality were extracted from the original studies, individual patient data provided from the principal investigators of eligible studies or the earlier published meta-analysis. The incidences of postoperative morbidities and mortalities were also analysed. In total 18 studies were eligible and data were available from 14 of these. The meta-analysis on overall survival yielded HRs of 0.75 (95% CI 0.65-0.86, P < 0.001) for preoperative (chemo)radiotherapy and 0.83 (95% CI 0.67-1.01, P = 0.065) for preoperative chemotherapy when compared to surgery alone. Direct comparison between preoperative chemoradiotherapy and chemotherapy resulted in an HR of 0.71 (95% CI 0.45-1.12, P = 0.146). Combination of direct and adjusted indirect comparisons yielded an HR of 0.86 (95% CI 0.69-1.07, P = 0.171). No statistically significant differences were seen in the risk for postoperative morbidity or mortality between preoperative treatments and surgery alone, or preoperative (chemo)radiotherapy and chemotherapy. Preoperative (chemo)radiotherapy for gastric and GOJ cancer showed significant survival benefit over surgery alone. In comparisons between preoperative chemotherapy and (chemo)radiotherapy, there is a trend towards improved survival when adding radiotherapy, without increased postoperative morbidity or mortality.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- Stomach
- Gastro-oesophageal junction
- Adenocarcinoma
- Preoperative chemotherapy
- Preoperative chemoradiotherapy
Publication and Content Type
- ref (subject category)
- for (subject category)
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To the university's database
- By the author/editor
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Kumagai, K.
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Rouvelas, I.
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Tsai, J. A.
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Mariosa, D.
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Lind, Pehr A.
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Lindblad, M.
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show more...
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Ye, W.
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Lundell, L.
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Schuhmacher, C.
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Mauer, M.
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Burmeister, B. H ...
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Thomas, J. M.
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Stahl, M.
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Nilsson, M.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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European Journal ...
- By the university
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Uppsala University
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Karolinska Institutet