Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.1046
Peer-review started: December 21, 2023
First decision: January 13, 2024
Revised: January 14, 2024
Accepted: February 4, 2024
Article in press: February 4, 2024
Published online: March 15, 2024
Processing time: 82 Days and 7 Hours
Gastric cancer (GC) is the fifth most commonly diagnosed malignancy worldwide, with over 1 million new cases per year, and the third leading cause of cancer-related death.
To determine the optimal perioperative treatment regimen for patients with locally resectable GC.
A comprehensive literature search was conducted, focusing on phase II/III randomized controlled trials (RCTs) assessing perioperative chemotherapy and chemoradiotherapy in treating locally resectable GC. The R0 resection rate, overall survival (OS), disease-free survival (DFS), and incidence of grade 3 or higher nonsurgical severe adverse events (SAEs) associated with various perioperative regimens were analyzed. A Bayesian network meta-analysis was performed to compare treatment regimens and rank their efficacy.
Thirty RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared with surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for improving OS. Owing to limited data, no definitive ranking could be determined for DFS. Considering nonsurgical SAEs, FLO has emerged as the safest treatment regimen.
This study provides valuable insights for clinicians when selecting perioperative treatment regimens for patients with locally resectable GC. Further studies are required to validate these findings.
Core Tip: This study provides an update of the literature on perioperative therapy for locally resectable gastric cancer (GC) as of April 21, 2023. This study aimed to provide a multidimensional approach to perioperative treatment regimens for resectable GC using Bayesian network meta-analysis.