Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 1046-1058
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.1046
Efficacy and safety of perioperative therapy for locally resectable gastric cancer: A network meta-analysis of randomized clinical trials
Zi-Yu Kuang, Qian-Hui Sun, Lu-Chang Cao, Xin-Yi Ma, Jia-Xi Wang, Ke-Xin Liu, Jie Li
Zi-Yu Kuang, Graduate College, Beijing University of Traditional Chinese Medicine, Beijing 100029, China
Qian-Hui Sun, Lu-Chang Cao, Xin-Yi Ma, Jia-Xi Wang, Ke-Xin Liu, Jie Li, Oncology Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Co-first authors: Zi-Yu Kuang and Qian-Hui Sun.
Author contributions: Li L mainly conceived this manuscript and gave instructions. Kuang ZY, Sun QH, and Cao LC critically analyzed the current literature and wrote the original manuscript; Ma XY, Wang JX, and Liu KX were responsible for extracting data and drawing charts; all authors have read and agreed to the published version of the manuscript. Kuang ZY and Sun QH are the co-first authors of this study as this study was conceived by Kuang ZY and Sun QH.
Supported by National Natural Science Foundation of China, No. 82305347.
Conflict-of-interest statement: Authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Li, MD, PhD, Chief Doctor, Doctor, Oncology Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 North Line Pavilion, Xicheng District, Beijing 100053, China. qfm2020jieli@yeah.net
Received: December 21, 2023
Peer-review started: December 21, 2023
First decision: January 13, 2024
Revised: January 14, 2024
Accepted: February 4, 2024
Article in press: February 4, 2024
Published online: March 15, 2024
Processing time: 82 Days and 7 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is the fifth most commonly diagnosed malignancy worldwide, with over 1 million new cases per year, and the third leading cause of cancer-related death.

Research motivation

To conduct a systematic search for randomized controlled trials (RCTs) involving resectable GC with perioperative chemotherapy and/or radiotherapy and rank them based on R0 resection rate, overall survival (OS), disease-free survival (DFS), and safety using Bayesian NMA. The ultimate goal was to identify the optimal treatment regimen and provide valuable clinical guidance.

Research objectives

To determine the optimal perioperative treatment regimen for locally resectable GC.

Research methods

A comprehensive literature search was conducted focusing on phase II/III RCTs assessing perioperative chemotherapy and chemoradiotherapy in locally resectable GC. The R0 resection rate, OS, DFS, and incidence of grade 3 or non-surgical grade 3 or higher nonsurgical severe adverse events (SAEs) associated with various perioperative regimens were analyzed. Bayesian network meta-analysis was performed to compare the treatment regimens and rank their efficacy.

Research results

A total of 30 RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared to surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for OS. Due to limited data, no definitive ranking could be determined for DFS. Considering non-surgical SAEs, FLO emerged as the safest regimen.

Research conclusions

A total of 30 RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared to surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for OS. Due to limited data, no definitive ranking could be determined for DFS. Considering non-surgical SAEs, FLO emerged as the safest regimen.

Research perspectives

Our findings may provide some guidance to clinicians in selecting the appropriate treatment regimens. However, it is important to consider the limitations of this study and exercise caution when interpreting its conclusions. Future RCTs with rigorous designs and large sample sizes are needed to validate the findings. Given the advancements in targeted therapy and immunotherapy, it would be valuable to further explore the potential survival benefits of combining basic chemotherapy with targeted therapies and immunotherapy for locally resectable GC in future research.