Zhai Yuhao, Zheng Zhi, Deng Wei, Yin Jie, Bai Zhigang, Liu Xiaoye, Zhang Jun, Zhang Zhongtao
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Surg. 2023 Jan 16;9:1047456. doi: 10.3389/fsurg.2022.1047456. eCollection 2022.
The efficacy of neoadjuvant chemotherapy for advanced gastric cancer is not yet firmly confirmed, but the exciting results demonstrated in several clinical studies have led neoadjuvant chemotherapy as the important treatment methods in guidelines. The 4-6 weeks interval time is currently the most commonly used in clinical treatment, but there are insufficient studies to support this time and the optimal interval has not yet been identified. The aim of this meta-analysis was to investigate the short-term life quality and long-term prognostic impact of the interval time between the end of neoadjuvant chemotherapy and surgery in patients with advanced gastric cancer.
We conducted a systematic literature search in PUBMED, Embase and Cochrane Liabrary for studies published or reported in English from January 2006 to May 2022. We summarised relevant studies for the time to surgery (TTS), included as retrospective studies and prospective studies. The primary study outcome was the rate of pathological complete response (pCR), and the secondary outcomes included R0 resection rate, incidence of serious postoperative complications, 3-year progression free survival time (PFS) rate and overall survival time (OS) rate. TTS were classified in three groups: 4-6 weeks, <4 weeks and >6 weeks. The ratio ratios (ORs) were calculated and forest plots and funnel plots were made to analysis by using fixed-effect and random-effect models in Review Manager 5.2.
A total of five studies included 1,171 patients: 411 patients in shorter TTS group (<4 weeks), 507 patients in medium TTS group (4-6 weeks) and 253 patients in longer TTS groups (>6 weeks). And The results of our meta-analysis indicate that there are no significant difference between the three groups. The pCR, R0 resection rate, incidence of serious postoperative complications, 3-year PFS and OS were similar between three groups.
Although there many studies exploring the suitable TTS in advanced gastric cancer, but we have not find the evidence to prove the TTS is the risk factor influencing the outcome.
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022369009.
新辅助化疗对晚期胃癌的疗效尚未得到确凿证实，但多项临床研究显示的令人振奋的结果已使新辅助化疗成为指南中的重要治疗方法。目前，4至6周的间隔时间是临床治疗中最常用的，但支持这一间隔时间的研究不足，且尚未确定最佳间隔时间。本荟萃分析的目的是探讨晚期胃癌患者新辅助化疗结束至手术之间的间隔时间对短期生活质量和长期预后的影响。
我们在PUBMED、Embase和Cochrane图书馆进行了系统的文献检索，以查找2006年1月至2022年5月期间以英文发表或报道的研究。我们总结了关于手术时间（TTS）的相关研究，包括回顾性研究和前瞻性研究。主要研究结局是病理完全缓解（pCR）率，次要结局包括R0切除率、严重术后并发症发生率、3年无进展生存期（PFS）率和总生存期（OS）率。TTS分为三组：4至6周、<4周和>6周。计算比值比（OR），并在Review Manager 5.2中使用固定效应和随机效应模型制作森林图和漏斗图进行分析。
共有五项研究纳入了1171例患者：TTS较短组（<4周）有411例患者，TTS中等组（4至6周）有507例患者，TTS较长组（>6周）有253例患者。我们的荟萃分析结果表明，三组之间无显著差异。三组之间的pCR、R0切除率、严重术后并发症发生率、3年PFS和OS相似。
尽管有许多研究在探索晚期胃癌合适的TTS，但我们尚未找到证据证明TTS是影响结局的危险因素。
