The Efficacy Of Neoadjuvant Therapy For Locally Advanced Gallbladder Cancer: A Meta-analysis

Objective: Meta-analysis was used to systematically evaluate the efficacy of neoadjuvant therapy for locally advanced gallbladder cancer,to explore the application of neoadjuvant therapy in locally advanced gallbladder cancer.Methods: PubMed,Embase,The Cochrane Library,CNKI,wan fang and other databases were searched to collect the clinical studies on the efficacy of neoadjuvant therapy for locally advanced gallbladder cancer.Meta-analysis was performed on the collected studies by using RevMan5.3 software.Results: Nine clinical studies were included.A total of 511 patients received neoadjuvant therapy,of which 435 patients(85.1%)received neoadjuvant chemotherapy and 76 patients(14.9%)received neoadjuvant chemoradiotherapy.Results of meta-analysis showed that the tumor response rate after neoadjuvant therapy was 45%(95%CI=0.32-0.59,P < 0.00001);The clinical benefit rate was 73%(95%CI=0.69-0.78,P < 0.00001);The surgical resection rate was 43%(95%CI=0.30-0.56,P < 0.00001),the R0 resection rate was 36%(95%CI=0.23-0.48,P < 0.00001);the overall survival was higher in the resectable group than in the non-resectable group(MD=34.22,95%CI=30.45-37.99),and the difference was statistically significant(P < 0.00001).Conclusions: Down-staging after neoadjuvant therapy is noticeable in patients with locally advanced gallbladder cancer,neoadjuvant therapy can increase the chance of surgical resection of locally advanced gallbladder cancer,improve the R0 resection rate,and improve the overall survival of patients.However,more large samples and high-quality clinical studies are needed to explore the role of neoadjuvant therapy in the treatment of locally advanced gallbladder cancer.