Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review
Our study aimed to evaluate the benefits of chemoradiotherapy (CRT) after D2 gastrectomy, as compared to adjuvant chemotherapy, alone. PubMed, MEDLINE, Embase, and the Cochrane Library were systematically searched. We applied stepwise analyses that enabled the evaluation of data from randomized cont...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/12/8/2125 |
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| author | Chai Hong Rim In-Soo Shin Hye Yoon Lee Won Sup Yoon Sunmin Park |
| author_facet | Chai Hong Rim In-Soo Shin Hye Yoon Lee Won Sup Yoon Sunmin Park |
| author_sort | Chai Hong Rim |
| collection | DOAJ |
| description | Our study aimed to evaluate the benefits of chemoradiotherapy (CRT) after D2 gastrectomy, as compared to adjuvant chemotherapy, alone. PubMed, MEDLINE, Embase, and the Cochrane Library were systematically searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies, and all studies separately and in a hierarchical manner. Thirteen controlled studies, including six RCTs involving 2603 patients, were included. Overall pooled analysis revealed a disease-free survival benefit of CRT (odds ratio (OR): 1.264, <i>p</i> = 0.053), which was more evident in the subgroup analysis of RCTs (OR: 1.440, <i>p</i> = 0.006) and balanced studies (OR: 1.417, <i>p</i> < 0.001). Overall survival was insignificantly different in the overall pooled analysis (OR: 1.124, <i>p</i> = 0.347). However, the difference was marginally significant in the subgroup analysis of balanced studies (OR: 1.279, <i>p</i> = 0.055) and significant in the subgroup analysis of studies involving stage ≥III patients only (OR: 1.663, <i>p</i> = 0.005). Locoregional recurrence (LRR) reduction was noted in the overall pooled analysis (OR: 0.559, <i>p</i> = 0.012; pooled rate: 11.3% vs. 18.1%) and was more robust in the subgroup analyses. Grade ≥3 leukopenia was higher in the CRT arm (OR: 1.387, <i>p</i> = 0.004; pooled rate: 26.4% vs. 15.7%). CRT after D2 gastrectomy should be applied for patients with high risk of LRR (e.g., stage ≥ III), along with efforts to reduce leukopenia. |
| first_indexed | 2024-03-10T18:03:58Z |
| format | Article |
| id | doaj.art-3623ecbb44084788bdebeb444bd778a4 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T18:03:58Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-3623ecbb44084788bdebeb444bd778a42023-11-20T08:37:58ZengMDPI AGCancers2072-66942020-07-01128212510.3390/cancers12082125Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic ReviewChai Hong Rim0In-Soo Shin1Hye Yoon Lee2Won Sup Yoon3Sunmin Park4Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Gyeonggido 15355, KoreaGraduate school of Education, Dongguk University, Seoul 04620, KoreaDepartment of General Surgery, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggido 15355, KoreaDepartment of Radiation Oncology, Ansan Hospital, Korea University Medical College, Gyeonggido 15355, KoreaDepartment of Radiation Oncology, Ansan Hospital, Korea University Medical College, Gyeonggido 15355, KoreaOur study aimed to evaluate the benefits of chemoradiotherapy (CRT) after D2 gastrectomy, as compared to adjuvant chemotherapy, alone. PubMed, MEDLINE, Embase, and the Cochrane Library were systematically searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies, and all studies separately and in a hierarchical manner. Thirteen controlled studies, including six RCTs involving 2603 patients, were included. Overall pooled analysis revealed a disease-free survival benefit of CRT (odds ratio (OR): 1.264, <i>p</i> = 0.053), which was more evident in the subgroup analysis of RCTs (OR: 1.440, <i>p</i> = 0.006) and balanced studies (OR: 1.417, <i>p</i> < 0.001). Overall survival was insignificantly different in the overall pooled analysis (OR: 1.124, <i>p</i> = 0.347). However, the difference was marginally significant in the subgroup analysis of balanced studies (OR: 1.279, <i>p</i> = 0.055) and significant in the subgroup analysis of studies involving stage ≥III patients only (OR: 1.663, <i>p</i> = 0.005). Locoregional recurrence (LRR) reduction was noted in the overall pooled analysis (OR: 0.559, <i>p</i> = 0.012; pooled rate: 11.3% vs. 18.1%) and was more robust in the subgroup analyses. Grade ≥3 leukopenia was higher in the CRT arm (OR: 1.387, <i>p</i> = 0.004; pooled rate: 26.4% vs. 15.7%). CRT after D2 gastrectomy should be applied for patients with high risk of LRR (e.g., stage ≥ III), along with efforts to reduce leukopenia.https://www.mdpi.com/2072-6694/12/8/2125D2 gastrectomystomach cancergastric cancerchemoradiotherapyradiation therapy |
| spellingShingle | Chai Hong Rim In-Soo Shin Hye Yoon Lee Won Sup Yoon Sunmin Park Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review Cancers D2 gastrectomy stomach cancer gastric cancer chemoradiotherapy radiation therapy |
| title | Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review |
| title_full | Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review |
| title_fullStr | Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review |
| title_full_unstemmed | Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review |
| title_short | Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review |
| title_sort | oncologic benefit of adjuvant chemoradiation after d2 gastrectomy a stepwise hierarchical pooled analysis and systematic review |
| topic | D2 gastrectomy stomach cancer gastric cancer chemoradiotherapy radiation therapy |
| url | https://www.mdpi.com/2072-6694/12/8/2125 |
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