The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis
Abstract Background Neoadjuvant chemotherapy (NAC) for locally advanced gastric and gastroesophageal junction adenocarcinoma (LAGC) has been recommended in several guidelines. However, there is no global consensus about the optimum of NAC regimens. We aimed to determine the optimal NAC regimen for L...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-022-00878-7 |
| _version_ | 1798018209305067520 |
|---|---|
| author | Tongya Wang Changyang Li Xiang Li Jing Zhai Shoulin Wang Lizong Shen |
| author_facet | Tongya Wang Changyang Li Xiang Li Jing Zhai Shoulin Wang Lizong Shen |
| author_sort | Tongya Wang |
| collection | DOAJ |
| description | Abstract Background Neoadjuvant chemotherapy (NAC) for locally advanced gastric and gastroesophageal junction adenocarcinoma (LAGC) has been recommended in several guidelines. However, there is no global consensus about the optimum of NAC regimens. We aimed to determine the optimal NAC regimen for LAGC. Methods A systematic review and Bayesian network meta-analysis was performed. The literature search was conducted from inception to June 2022. The odds ratio (OR) value and 95% confidence interval (95% CI) were used for assessment of R0 resection rate and pathological complete response rate (pCR) as primary outcomes. The hazard ratio (HR) value and 95% CI were interpreted for the assessment of overall survival (OS) and disease-free survival (DFS) as second outcomes. The risk ratio (RR) value and 95% CI were used for safety assessment. Results Twelve randomized controlled trials were identified with 3846 eligible participants. The network plots for R0 resectability, OS, and DFS constituted closed loops. The regimens of TPF (taxane and platinum plus fluoropyrimidine), ECF (epirubicin and cisplatin plus fluorouracil), and PF (platinum plus fluoropyrimidine) showed a meaningful improvement of R0 resectability, as well as OS and/or DFS, compared with surgery (including surgery-alone and surgery plus postoperative adjuvant chemotherapy). Importantly, among these regimens, TPF regimen showed significant superiority in R0 resection rate (versus ECF regimen), OS (versus ECF regimen), DFS (versus PF and ECF regimens), and pCR (versus PF regimen). Conclusions The taxane-based triplet regimen of TPF is likely the optimal neoadjuvant chemotherapy regimen for LAGC patients. |
| first_indexed | 2024-04-11T16:20:16Z |
| format | Article |
| id | doaj.art-a0e2f13a3b094303849b0f4d7d061431 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-04-11T16:20:16Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-a0e2f13a3b094303849b0f4d7d0614312022-12-22T04:14:25ZengBMCEuropean Journal of Medical Research2047-783X2022-11-0127111010.1186/s40001-022-00878-7The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysisTongya Wang0Changyang Li1Xiang Li2Jing Zhai3Shoulin Wang4Lizong Shen5Department of Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese MedicineDepartment of General Surgery, Affiliated Hospital of Integrated Chinese and Western Medicine, Nanjing University of Chinese MedicineDepartment of Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese MedicineDepartment of Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese MedicineSchool of Public Health, Nanjing Medical UniversityDepartment of Surgical Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese MedicineAbstract Background Neoadjuvant chemotherapy (NAC) for locally advanced gastric and gastroesophageal junction adenocarcinoma (LAGC) has been recommended in several guidelines. However, there is no global consensus about the optimum of NAC regimens. We aimed to determine the optimal NAC regimen for LAGC. Methods A systematic review and Bayesian network meta-analysis was performed. The literature search was conducted from inception to June 2022. The odds ratio (OR) value and 95% confidence interval (95% CI) were used for assessment of R0 resection rate and pathological complete response rate (pCR) as primary outcomes. The hazard ratio (HR) value and 95% CI were interpreted for the assessment of overall survival (OS) and disease-free survival (DFS) as second outcomes. The risk ratio (RR) value and 95% CI were used for safety assessment. Results Twelve randomized controlled trials were identified with 3846 eligible participants. The network plots for R0 resectability, OS, and DFS constituted closed loops. The regimens of TPF (taxane and platinum plus fluoropyrimidine), ECF (epirubicin and cisplatin plus fluorouracil), and PF (platinum plus fluoropyrimidine) showed a meaningful improvement of R0 resectability, as well as OS and/or DFS, compared with surgery (including surgery-alone and surgery plus postoperative adjuvant chemotherapy). Importantly, among these regimens, TPF regimen showed significant superiority in R0 resection rate (versus ECF regimen), OS (versus ECF regimen), DFS (versus PF and ECF regimens), and pCR (versus PF regimen). Conclusions The taxane-based triplet regimen of TPF is likely the optimal neoadjuvant chemotherapy regimen for LAGC patients.https://doi.org/10.1186/s40001-022-00878-7Gastric cancerGastroesophageal junction cancerNeoadjuvant chemotherapySystematic reviewBayesian network meta-analysis |
| spellingShingle | Tongya Wang Changyang Li Xiang Li Jing Zhai Shoulin Wang Lizong Shen The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis European Journal of Medical Research Gastric cancer Gastroesophageal junction cancer Neoadjuvant chemotherapy Systematic review Bayesian network meta-analysis |
| title | The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis |
| title_full | The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis |
| title_fullStr | The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis |
| title_full_unstemmed | The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis |
| title_short | The optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma: a systematic review and Bayesian network meta-analysis |
| title_sort | optimal neoadjuvant chemotherapy regimen for locally advanced gastric and gastroesophageal junction adenocarcinoma a systematic review and bayesian network meta analysis |
| topic | Gastric cancer Gastroesophageal junction cancer Neoadjuvant chemotherapy Systematic review Bayesian network meta-analysis |
| url | https://doi.org/10.1186/s40001-022-00878-7 |
| work_keys_str_mv | AT tongyawang theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT changyangli theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT xiangli theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT jingzhai theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT shoulinwang theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT lizongshen theoptimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT tongyawang optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT changyangli optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT xiangli optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT jingzhai optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT shoulinwang optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis AT lizongshen optimalneoadjuvantchemotherapyregimenforlocallyadvancedgastricandgastroesophagealjunctionadenocarcinomaasystematicreviewandbayesiannetworkmetaanalysis |