Systematic Evaluation Of The Safety And Long-term Effect Of Neoadjuvant Chemotherapy On Gastric Cancer

Objective: To evaluate the safety and long-term effect of neoadjuvant chemotherapy in the treatment of gastric cancer.Methods: The studies published before December 2017 about evaluating the safety and long-term efficacy of neoadjuvant chemotherapy for gastric cancer were collected through searching several national and international databases.Evaluating the quality of the included literature and extracting relevant information,the data were analyzed by Revman5.3 software.The heterogeneity of the included literatures was analyzed.Furthermore the the pooled effect in the included studies were calculated,which including the R0 resection rate、5-year survival rate and so on.If there is heterogeneity,the related literature is eliminated one by one in order to find the source of heterogeneity.The publication bias caused by the included studies about major endpoints was evaluated by drawing funnel plot.Results: A total of 21 randomized controlled trials with a total of 2633 patients were included.NAC group showed a significant increase in 2-year survival rate(OR = 1.64,CI: 1.19-2.25 95%,P = 0.002),5-year survival rate(OR = 1.73,CI: 1.17-2.25 95%,P = 0.006)and R0 resection rate(OR = 1.55,95% CI: 1.23-1.96,P=0.0002).The tumor down-staging rate(OR = 1.91,95% CI: 1.40-2.61,P < 0.00001)was reduced by NAC;There were no significant difference in terms of postoperative complications and perioperative mortality between the two groups.Subgroup analysis showed that the3-year survival and 5-year survival rate of the treatment arm that involved both NAC and PAC was superior than only NAC.The OR of 3-year survival and 5-year survival rate are respectively(1.50,95%CI:1.07-2.09,P=0.02)、(1.47,95CI:1.08-1.99,P=0.01).Conclusion:The safety of NAC is certain.However,there is a bad conclusion that the treatment of only neoadjuvant chemotherapy does not improve its long-term survival.In addition,the long-term survival rate of NAC combined with postoperative chemotherapy is higher than only postoperative chemotherapy,which can be used as the focus of future research.