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 conduct a systematic search for randomized controlled trials (RCTs) involving resectable GC with perioperative chemotherapy and/or radiotherapy and rank them based on R0 resection rate, overall survival (OS), disease-free survival (DFS), and safety using Bayesian NMA. The ultimate goal was to identify the optimal treatment regimen and provide valuable clinical guidance.
To determine the optimal perioperative treatment regimen for locally resectable GC.
A comprehensive literature search was conducted focusing on phase II/III RCTs assessing perioperative chemotherapy and chemoradiotherapy in locally resectable GC. The R0 resection rate, OS, DFS, and incidence of grade 3 or non-surgical grade 3 or higher nonsurgical severe adverse events (SAEs) associated with various perioperative regimens were analyzed. Bayesian network meta-analysis was performed to compare the treatment regimens and rank their efficacy.
A total of 30 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 to 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 OS. Due to limited data, no definitive ranking could be determined for DFS. Considering non-surgical SAEs, FLO emerged as the safest regimen.
A total of 30 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 to 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 OS. Due to limited data, no definitive ranking could be determined for DFS. Considering non-surgical SAEs, FLO emerged as the safest regimen.
Our findings may provide some guidance to clinicians in selecting the appropriate treatment regimens. However, it is important to consider the limitations of this study and exercise caution when interpreting its conclusions. Future RCTs with rigorous designs and large sample sizes are needed to validate the findings. Given the advancements in targeted therapy and immunotherapy, it would be valuable to further explore the potential survival benefits of combining basic chemotherapy with targeted therapies and immunotherapy for locally resectable GC in future research.