| Objective: The aim of this study was to perform a systematic review of outcome and prognostic factors for survival of conversion therapy for advanced gastric cancer patients.Methods: Chinese search terms: advanced gastric cancer,stage IV gastric cancer,advanced gastric cancer,conversion therapy,conversion surgery,prognostic factors,efficacy analysis.English search terms: advanced gastric cancer,stage IV gastric cancer,conversion therapy,conversion surgery,survival,prognostic factors.We searched Chinese Journal Full Text Database,Wanfang Database,Vip database,SinoMed,Pubmed,EMBASE,Cochrane Library,Medline,Springerlink,Wiley Online Library.The search deadline is December 1,2018.Two researchers independently screened the literature and extracted the data,and used Newcastle-Ottawa Quality Assessment Scale(NOS)to assess the quality of each study.Based on the heterogeneity of the included studies,statistical analyzes using either fixed or random effects models were performed to calculate the hazard ratio(HR)and 95% confidence interval(95% CI).We also conducted subgroup analysis,sensitivity analysis and publication bias related assessment.Results:After reading the abstracts and full texts of 2144 articles were searched,9studies and 877 patients were eligible for the final analysis.The results of Meta-analysis showed:Conversion therapy reduced the risk of death by about 66%(HR 0.34,95% CI:[0.28,0.41],P<0.05)and improved the overall survival compared with that of patients were treated with chemotherapy alone in patients with advanced gastric cancer.The weighted average of the median survival time and the 95% CI of the conversion therapy group and chemotherapy alone group were 37.9 months(33.8,42.0)and 12.7 months(11.8,13.6).Conversion therapy can extend the median survival(MST)of patients with advanced gastric cancer by approximately 2.74 times(HR 2.74,95% CI: [2.27,3.30],P <0.05).In terms of objective response rate of chemotherapy,the three-drug combination chemotherapy regimen(DCS)has a higher advantage than the two-drug combination chemotherapy regimen(SP/TS/SOX/XELOX)(78.3% versus 64.5%),P<0.05,the difference was statistically significant.In terms of conversion rate,the three-drug regimen compared with the two-drug regimen is 42.7% versus 41.8%,P>0.05,no significantconversion advantage was found in the three-drug regimen.In terms of pathological response rate,the combination of three drugs was more significant than the combination of the two drugs(73.7% versus 56.1%),P<0.05,the difference was statistically significant.In terms of the incidence of postoperative complications,no significant differences were found in different chemotherapy regimens(three-drug versus two-drug: 27.2% versus27.5%,P > 0.05).Multivariate prognostic analysis,whether the tumor was potentially resectable,the site of metastases,the number of unresectable factors,whether R0 resection,chemotherapy response rate,and pathological response rate were important prognostic factors.Conclusions: Conversion therapy can reduce the risk of death and significantly improve the overall survival rate of patients with advanced gastric cancer.Compared with conventional radical gastrectomy(D2),the incidence of postoperative complications did not increase.Patients with advanced gastric cancer are expected to achieve long-term survival after conversion therapy. |
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