Adjuvant Treatments As Firt-Line For Patients With Locally Advanced Or Metastatic Gastric Cancer:A Network Meta-Analysis

Background:In recent years, there’re too many randomized controlled trials(RCT) study on the first line chemotherapy regimens in locally and metastatic advanced gastric cancer. However, due to the lack of direct comparison between each treatment regimen, the best treatment method was uncertain. Our objective is to make a comparison of overall survival and progression free survival between locally progressive and metastatic advanced gastric cancer patients who have already received traditional first line chemotherapy after tumor resection by means of Bayesian network meta-analysis. We attempted to provide the assessment in the benefits of adjuvant chemotherapy treatment in order to assist the clinicians to make the optimal treatment in clinical practice.Methods:We collected the data for randomized controlled trials III phase from PUBMED, EMBASE, CliniacalTrials.gov, Cochrane library, and American Society of Clinical Oncology database reviews before March 30,2015, comparing the different kind of first line chemotherapy regimens with one another mentioned as above and simple operation. We assessed the therapeutic effects of these traditional first line chemo regimens by comparing the hazard ratios (HR) for death and survival durations and progression free survival of different kinds of chemo regimens from collected data. We accomplished the comparison of direct and indirect evidences of traditional first line chemotherapy regimens in the patients with locally advanced and metastatic gastric cancer after surgery by applying Bayesian statistical model, network meta-analysis.Result:Compared with surgery alone. Network meta-analysis revealed that the combination used of Leucovorin,5-FU and Epidoxorubicin(EPLF) is statistically significant in improvement of overall survival, the HRs for death is 0.52(95% credible interva10.34-0.77).Area under cumulative probability curve revealed that combined EPLF treatment regimens has the highest possibility to be the best treatment regimens in overall survival.Conclusion:Our study make clear that the combination treatment regimen of EPLF in management of locally progressive and metastatic advanced gastric cancer is better than other regimens. In conclusion, our study provide a good basis to make the best treatment regimen for clinicians in clinical practice.