Fiflis Stylianos, Papakonstantinou Menelaos, Giakoustidis Alexandros, Christodoulidis Gregory, Louri Eleni, Papadopoulos Vasileios N, Giakoustidis Dimitrios
A' Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece.
Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece.
World J Gastrointest Surg. 2023 Aug 27;15(8):1808-1818. doi: 10.4240/wjgs.v15.i8.1808.
Gastric cancer (GC) is a major health concern worldwide. Surgical resection and chemotherapy is the mainstay treatment for gastric carcinoma, however, the optimal approach remains unclear and should be different in each individual. Chemotherapy can be administered both pre- and postoperatively, but a multidisciplinary approach is preferred when possible. This is particularly relevant for locally advanced GC (LAGC), as neoadjuvant chemotherapy (NAT) could potentially lead to tumor downsizing thus allowing for a complete resection with curative intent. Even though the recent progress has been impressive, European and International guidelines are still controversial, thus attenuating the need for a more standardized approach in the management of locally advanced cancer.
To investigate the effects of NAT on the overall survival (OS), the disease-free survival (DFS), the morbidity and the mortality of patients with LAGC in comparison to upfront surgery (US).
For this systematic review, a literature search was conducted between November and February 2023 in PubMed, Cochrane Library and clinicaltrials.gov for studies including patients with LAGC. Two independent reviewers conducted the research and extracted the data according to predetermined inclusion and exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to form the search strategy and the study protocol has been registered in the International Prospective Register of Systematic Reviews.
Eighteen studies with 4839 patients with LAGC in total were included in our systematic review. Patients were separated into two groups; one receiving NAT before the gastrectomy (NAT group) and the other undergoing upfront surgery (US group). The OS ranged from 41.6% to 74.2% in the NAT group and from 30.9% to 74% in the US group. The DFS was also longer in the NAT group and reached up to 80% in certain patients. The complications related to the chemotherapy or the surgery ranged from 6.4% to 38.1% in the NAT group and from 5% to 40.5% in the US group. Even though in most of the studies the morbidity was lower in the NAT group, a general conclusion could not be drawn as it seems to depend on multiple factors. Finally, regarding the mortality, the reported rate was higher and up to 5.3% in the US group.
NAT could be beneficial for patients with LAGC as it leads to better OS and DFS than the US approach with the same or even lower complication rates. However, patients with different clinicopathological features respond differently to chemotherapy, therefore currently the treatment plan should be individualized in order to achieve optimal results.
胃癌（GC）是全球主要的健康问题。手术切除和化疗是胃癌的主要治疗方法，然而，最佳方法仍不明确，且因人而异。化疗可在术前和术后进行，但尽可能采用多学科方法更佳。这对于局部晚期胃癌（LAGC）尤为重要，因为新辅助化疗（NAT）可能会使肿瘤缩小，从而实现根治性完全切除。尽管最近取得了令人瞩目的进展，但欧洲和国际指南仍存在争议，因此在局部晚期癌症的管理中更需要一种标准化方法。
比较新辅助化疗（NAT）与直接手术（US）对局部晚期胃癌（LAGC）患者总生存期（OS）、无病生存期（DFS）、发病率和死亡率的影响。
为进行这项系统评价，于2023年11月至2月在PubMed、Cochrane图书馆和clinicaltrials.gov上检索了包括局部晚期胃癌（LAGC）患者的研究。两名独立的评审员进行研究，并根据预先确定的纳入和排除标准提取数据。采用系统评价和Meta分析的首选报告项目来形成检索策略，研究方案已在国际系统评价前瞻性注册库中注册。
我们的系统评价共纳入了18项研究，总计4839例局部晚期胃癌（LAGC）患者。患者分为两组；一组在胃切除术前接受新辅助化疗（NAT组），另一组接受直接手术（US组）。NAT组的总生存期（OS）在41.6%至74.2%之间，US组在30.9%至74%之间。NAT组的无病生存期（DFS）也更长，某些患者可达80%。NAT组与化疗或手术相关的并发症在6.4%至38.1%之间，US组在5%至40.5%之间。尽管在大多数研究中NAT组的发病率较低，但由于似乎取决于多种因素，无法得出一般性结论。最后，关于死亡率，US组报告的发生率更高，可达5.3%。
新辅助化疗（NAT）对局部晚期胃癌（LAGC）患者可能有益，因为与直接手术（US）方法相比，它能带来更好的总生存期（OS）和无病生存期（DFS），且并发症发生率相同甚至更低。然而，具有不同临床病理特征的患者对化疗的反应不同，因此目前治疗方案应个体化以取得最佳效果。
