Adjuvant chemoradiotherapy vs chemotherapy after R0 D2 gastrectomy for gastric cancer: Meta-analysis of randomized trials

Figure 1 PRISMA 2020 flow diagram. The publication-report and registry streams are shown separately to avoid double-counting registrations and reports. Counts reproduce the screening flow recorded in the original review; the exact search strategies and a record-level eligibility verification ledger are supplied in the audit materials.

Figure 2 Forest plot of disease-free survival/recurrence-free survival using the published Adjuvant Chemoradiotherapy in Stomach Tumors 2 CI (0. 663-1.421). Squares reflect inverse-variance weights; horizontal lines show study-level 95%CIs, and the diamond shows the restricted maximum likelihood pooled estimate with modified Knapp–Hartung inference. Hazard ratios below 1 favor chemoradiotherapy. N denotes the participants represented in each extracted comparison; The trial reported by Zhu et al[17] contributes 351 analyzed rather than 404 randomized participants. ARTIST: Adjuvant Chemoradiotherapy in Stomach Tumors; REML: Restricted maximum likelihood; HR: Hazard ratio; CRT: Chemoradiotherapy; CT: Chemotherapy.

Figure 3 Final RoB 2 judgments for the disease-free survival/recurrence-free survival outcome after author review. D1: Randomization process; D2: Deviations from intended interventions; D3: Missing outcome data; D4: Outcome measurement; D5: Selection of the reported result. The corresponding signalling-question rationale and source-access notes are provided in the audit workbook. The trial reported by Xie et al[20] was eligible qualitatively but did not contribute a hazard ratio to the quantitative synthesis. ARTIST: Adjuvant Chemoradiotherapy in Stomach Tumors.

Figure 4 Forest plot of overall survival. Study-level effects are standardized as chemoradiotherapy vs chemotherapy. The diamond shows the restricted maximum likelihood pooled hazard ratio with a modified Knapp-Hartung 95%CI. N reflects the participants represented in the extracted comparison. Legacy Kwon et al[15] and Kim et al[16] log-HR/SE inputs were taken from the 2016 secondary reconstruction. ARTIST: Adjuvant Chemoradiotherapy in Stomach Tumors; CRT: Chemoradiotherapy; CT: Chemotherapy; REML: Restricted maximum likelihood.