Comparative effectiveness of preoperative, postoperative and perioperative treatments for resectable gastric cancer: A network meta-analysis for the literature of past 20 years

Cai, Zhaolun; Yin, Yuan; Shen, Chaoyong; Zhang, B.

doi:10.1093/annonc/mdy151.070

Cited by 8 publications

(9 citation statements)

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“…This provided strong evidence that perioperative chemotherapy methods were also suitable for LAGC treatment in Asian patients. At the same time, meta-analysis suggested that perioperative chemotherapy was superior to traditional adjuvant chemotherapy for LAGC cases [36][37][38][39]. In our study, large retrospectively analyzed data was used through propensity score matching to further explore whether perioperative chemotherapy brought survival benefit to LAGC patients.…”

Section: Discussionmentioning

confidence: 98%

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Wang¹,

Zhang²,

Guo³

et al. 2020

J. Cancer

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Objective: There are controversial indications for neoadjuvant chemotherapy (NAT) in the treatment of locally advanced gastric cancer (LAGC). Here, we aimed to identify indications for NAT based on pre-treatment clinicopathological and laboratory parameters. Methods: This study included a retrospective cohort of 1083 LAGC patients who had underwent radical D2 gastrectomy in the Cancer Hospital of China Medical University between 2012 and 2016. After propensity score matching, 756 patients were recruited and were separated into NAT (n=378) or primary surgery (PS) (n=378) groups. Cox regression identified pre-treatment risk factors for overall survival (OS). A nomogram was established to predict OS and calculate scores for risk factors. Recursive partitioning analysis (RPA) determined cut off values, where the entire patient cohort was divided into low and high risk groups. Results: Seven risk factors that were significantly related to OS were incorporated in the nomogram. These risk factors included age, tumor size, tumor site, carbohydrate antigen 199 (CA199), carcino-embryonic antigen (CEA), clinical T stage (cT) and clinical N stage (cN). The model contained a C-index of 0.637. The calibration curve revealed anticipated values that were reflective of actual values. The decision curve revealed an achievement of optimal clinical impact when threshold possibility was 0-54%. Next, the cohort was split into low (≤ 252 points) or high (> 252 points) risk groups based on the 5-year OS projected by RPA. The PS group showed a worse OS compared to the NAT group for high-risk patients (P =0.004). There was no significant difference when comparing OS between the PS and NAT groups for low-risk patients (P =0.407). Conclusions: A feasible, quantifiable and practical prognostic tool was generated to screen for potential survival benefits for patients receiving NAT. Surgeons can use this model to identify optimal treatment regimens for individualized treatment strategies during the diagnosis of LAGC patients. For these patients, NAT is suggested for high-risk patients.

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Section: Discussionmentioning

confidence: 98%

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Wang¹,

Zhang²,

Guo³

et al. 2020

J. Cancer

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“…Globally, gastric cancer (GC), also known as stomach cancer, is one of the most common malignancies and the third-leading contributor to cancer deaths, accounting for 8.2% of the total mortality caused by tumors (1). The past several decades have witnessed a substantial decline in the incidence and mortality of GC (2), and there have been breakthroughs in the treatment of early-stage GC (3). However, GC has a high rate of recurrence, metastasis, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Prediction and prognostic significance of ALOX12B and PACSIN1 expression in gastric cancer by genome-wide RNA expression and methylation analysis

Liu¹,

Li²,

Li³

et al. 2021

J Gastrointest Oncol

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Background: Stomach adenocarcinoma (STAD) is one of the common gastrointestinal cancers, characterized by late discovery and metastasis. However, research of gene methylation and expression in gastric cancer (GC) metastasis has been quite limited. This study aimed to investigate the altered gene expression patterns between metastasis and non-metastasis samples using high-throughput RNA and methylation profiles from a large number of patients. Another aim was to identify a specific potential metastasis biomarker, with the ability to predict the metastasis possibility and prognosis of patients with STAD.Methods: In this study, we integrated The Cancer Genome Atlas (TCGA) program STAD datasets, analyzed the RNA expression and DNA methylation data between non-metastasis (M0) and distant metastasis (M1) samples, and evaluated the candidate biomarker in survival and prognosis of GC.Results: Among all patients enrolled, 329 with M0 and M1 information were positive for RNA analysis, and 353 with M0 and M1 information were positive for methylation analysis. We found 29 upregulated and 200 downregulated genes in RNA level, and 5,046 hypermethylated and 8,563 hypomethylated probes in methylation level. Among these genes, we found high RNA expression level and low DNA methylation level of ALOX12B and PACSIN1 in GC metastasis samples. Patients with high expression of these 2 genes had poor overall survival (OS), progression-free survival (PFS), and post-progression survival (PPS). Conclusions:The expression levels of ALOX12B and PACSIN1 were higher in the metastasis than nonmetastasis group, and participants with high expression of these 2 genes were found to have poor survival.The genes ALOX12B and PACSIN1 are potential biomarkers of metastasis and poor prognosis, especially in early stage GC, and provide additional information for subsequent comprehensive treatment of GC.

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“…The combined modality therapy significantly increases survival in patients with locoregional gastric cancer (5)(6)(7). The most common approach for localized resectable disease (≥cT2 and/or N+) is perioperative chemotherapy.…”

Section: Modality Of the Therapymentioning

confidence: 99%

Perioperative treatment of gastric cancer- short review

et al. 2021

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Adenocarcinoma of the gastroesophageal junction (GEJ) and gastric cancer have poor outcomes in most patients.Perioperative chemotherapy became a standard of care for resectable adenocarcinoma of the upper GI tract based on the results of the MAGIC trial. The study includes patients with Stage II or III resectable adenocarcinoma of the stomach, GEJ, and lower esophagus. The ACCORD trial essentially supported the results of the MAGIC study.Both studies showed that preoperative chemotherapy could induce downstaging and enhance the possibility of potentially curative R0 resection, thus increasing the probability of disease-free survival and overall survival.The NeoFLOT study investigates the application of prolonged neoadjuvant chemotherapy (NACT). This study indicates that NACT with six cycles of FLOT is highly effective in resectable gastroesophageal cancer. The CRITICS trial compares perioperative chemotherapy with preoperative and postoperative chemoradiotherapy in patients with resectable gastric adenocarcinoma. Postoperative chemoradiotherapy did not improve overall survival compared with postoperative chemotherapy in patients with resectable gastric cancer treated with adequate preoperative chemotherapy and surgery.In recent years, guidelines for the treatment of gastric cancer have changed frequently. Because gastric cancer treatment is complex and perioperative chemotherapy is present in all treatment guidelines, a multidisciplinary team with experienced physicians is the foundation of effective gastric cancer treatment.

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Comparative effectiveness of preoperative, postoperative and perioperative treatments for resectable gastric cancer: A network meta-analysis for the literature of past 20 years

Cited by 8 publications

References 0 publications

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Prediction and prognostic significance of ALOX12B and PACSIN1 expression in gastric cancer by genome-wide RNA expression and methylation analysis

Perioperative treatment of gastric cancer- short review

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