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Systematic review and meta-analysis of the outcomes following neoadjuvant therapy in upfront resectable gastric cancers compared to surgery alone in phase III randomised controlled trials

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Gastric cancer is the fifth most common malignancy and the fourth most common cause of cancer mortality globally. The role of neoadjuvant chemotherapy in upfront resectable gastric cancer is a subject of ongoing research. In recent meta-analyses, R0 resection rate and superior outcomes were not consistently observed in such regimens.

Aim

To describe the outcomes following phase III randomised control trials; comparing neoadjuvant therapy followed by surgery against upfront surgery with and without adjuvant therapy in resectable gastric cancers.

Methods

The Cochrane Library, CINAHL, EMBASE, PubMed, SCOPUS and Web of Science was searched from January 2002 to September 2022.

Results

13 studies were included (3280 participants). R0 resection rates were in neoadjuvant therapy arms as compared to adjuvant therapy with odds ratio (OR) 1.55[95% CI: 1.13, 2.13](p=0.007) and compared to surgery alone OR 2.49[95% CI: 1.56, 3.96](p=0.0001). 3-year and 5-year progression-, event- and disease-free survival in neoadjuvant therapy as compared to adjuvant therapy were not significantly increased, 3-year OR 0.87[0.71, 1.07](p=0.19). Meanwhile, comparing neoadjuvant therapy to adjuvant therapy, 3-year overall survival (OS) hazard ratio was 0.88[95% CI: 0.70, 1.11](p=0.71) while 3- and 5-year OS OR was 1.18[95% CI: 0.90, 1.55], p=0.22 and 1.27[95% CI: 0.67, 2.42](p=0.47) respectively. Surgical complications were also more common with neoadjuvant therapy.

Conclusion

Neoadjuvant therapy yields higher rates of R0 resection. However, improved long-term survival was not seen as compared to adjuvant therapy. Large multi-centred randomised control trials with D2 lymphadenectomy should be performed to better evaluate the treatment modalities.

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Acknowledgements

This study was not funded, we would like to thank Lee Kong Chian School of Medicine’s Library for their assistance with the search strategy.

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Authors and Affiliations

  1. Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore, Singapore

    Alva Lim Khai Shin, Adelina Ho Si Ying & Sarah Neo Hui Wen

  2. Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore

    Shanwen Charleen Yeo & Kon Voi Tay

  3. Department of Surgery, Woodlands Health Campus, 768024, Singapore, Singapore

    Kon Voi Tay

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  1. Alva Lim Khai Shin
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Contributions

Ho Si Ying, Adelina: acquisition, analysis and interpretation of data, manuscript drafting and approval, agreement for accountability for all aspects of the work

Lim Khai Shin, Alva: project development, acquisition, analysis and interpretation of data, manuscript drafting and approval, agreement for accountability for all aspects of the work

Sarah Neo Hui Wen: acquisition of data, manuscript drafting and approval, agreement for accountability for all aspects of the work

Charleen Yeo Shan Wen: project development, interpretation of data, manuscript drafting and approval, agreement for accountability for all aspects of the work

Tay Kon Voi: project development, interpretation of data, manuscript drafting and approval, agreement for accountability for all aspects of the work

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Correspondence to Shanwen Charleen Yeo.

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Lim Khai Shin, A., Ho Si Ying, A., Neo Hui Wen, S. et al. Systematic review and meta-analysis of the outcomes following neoadjuvant therapy in upfront resectable gastric cancers compared to surgery alone in phase III randomised controlled trials. J Gastrointest Surg 27, 1261–1276 (2023). https://doi.org/10.1007/s11605-023-05641-9

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