Comparative Effectiveness of Neoadjuvant Treatments for Resectable Gastroesophageal Cancer: A Network Meta-Analysis

Frontiers in Pharmacology

卷:9

Ye Zhou¹  Chaoyong Shen²  Zhaolun Cai²  Yuan Yin²  Zhou Zhao²  Jian Wang²  Xiaonan Yin²  Bo Zhang²  Zhixin Chen²  Yiqiong Yin²  Zhaohui Cai⁴  Chunyu Xin⁵ 

[1] Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China;

[2] Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China;

[3] Department of Infectious Disease, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China;

[4] The First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, China;

[5] West China College of Public Health, Sichuan University, Chengdu, China;

关键词: gastric cancer;    neoadjuvant;    chemotherapy;    chemoradiotherapy;    network meta-analysis;   

DOI  :  10.3389/fphar.2018.00872

来源: DOAJ

【 摘 要 】

Background: Several neoadjuvant treatments are available for patients with resectable gastroesophageal cancer. We did a Bayesian network meta-analysis (NMA) to compare available treatments, summarizing the direct and indirect evidence.Method: We searched relevant databases for randomized controlled trials of neoadjuvant treatments for resectable gastroesophageal cancer which compared two or more of the following treatments: surgery alone, perioperative docetaxel, oxaliplatin, leucovorin, and fluorouracil (FLOT), and neoadjuvant treatments listed in National Comprehensive Cancer Network guideline. Then we performed a NMA to summarize the direct and indirect evidence to estimate the relative efficacy for outcomes including overall survival (OS), progression-free survival and R0 resection rate. We calculated odds ratio (OR) and hazard ratio (HR) with 95% credible intervals (CrI) for dichotomous data and time-to-event data, respectively. We also calculated the surface under the cumulative ranking curve (SUCRA) value of each intervention to obtain a hierarchy of treatments.Result: Eight eligible trials (2434 patients) were included in our NMA. The treatment with the highest probability of benefit on OS as compared with surgery alone was perioperative FLOT [HR = 0.58 with 95% CrI: (0.43, 0.78), SUCRA = 93%], followed by preoperative radiotherapy, paclitaxel, and carboplatin (RT/PC) [HR = 0.68 with 95% CrI: (0.53, 0.87), SUCRA = 72%], perioperative cisplatin with fluorouracil (CF) [HR = 0.70 with 95% CrI: (0.51, 0.95), SUCRA = 68%], and perioperative epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) [HR = 0.75 with 95% CrI: (0.60, 0.94), SUCRA = 56%].Conclusion: Compared with surgery alone, perioperative CF, perioperative ECF/ECX, perioperative FLOT, and preoperative RT/PC significantly improved survival. Perioperative FLOT is likely to be the most effective neoadjuvant treatment for the disease. Further clinical studies are needed and justified.

【 授权许可】

Unknown