Kuang Zi-Yu, Sun Qian-Hui, Cao Lu-Chang, Ma Xin-Yi, Wang Jia-Xi, Liu Ke-Xin, Li Jie
Graduate College, Beijing University of Traditional Chinese Medicine, Beijing 100029, China.
Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):1046-1058. doi: 10.4251/wjgo.v16.i3.1046.
Gastric cancer (GC) is the fifth most commonly diagnosed malignancy worldwide, with over 1 million new cases per year, and the third leading cause of cancer-related death.
To determine the optimal perioperative treatment regimen for patients with locally resectable GC.
A comprehensive literature search was conducted, focusing on phase II/III randomized controlled trials (RCTs) assessing perioperative chemotherapy and chemoradiotherapy in treating locally resectable GC. The R0 resection rate, overall survival (OS), disease-free survival (DFS), and incidence of grade 3 or higher nonsurgical severe adverse events (SAEs) associated with various perioperative regimens were analyzed. A Bayesian network meta-analysis was performed to compare treatment regimens and rank their efficacy.
Thirty RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared with surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for improving OS. Owing to limited data, no definitive ranking could be determined for DFS. Considering nonsurgical SAEs, FLO has emerged as the safest treatment regimen.
This study provides valuable insights for clinicians when selecting perioperative treatment regimens for patients with locally resectable GC. Further studies are required to validate these findings.
胃癌（GC）是全球第五大最常被诊断出的恶性肿瘤，每年新增病例超过100万，是癌症相关死亡的第三大主要原因。
确定局部可切除胃癌患者的最佳围手术期治疗方案。
进行了全面的文献检索，重点关注评估围手术期化疗和放化疗治疗局部可切除胃癌的II/III期随机对照试验（RCT）。分析了与各种围手术期治疗方案相关的R0切除率、总生存期（OS）、无病生存期（DFS）以及3级或更高等级非手术严重不良事件（SAE）的发生率。进行了贝叶斯网络荟萃分析以比较治疗方案并对其疗效进行排名。
本研究纳入了30项涉及8346例患者的RCT。与单纯手术相比，新辅助XELOX加新辅助放疗和新辅助CF被发现可显著提高R0切除率，并且在此背景下前者成为最有效选择的概率最高。新辅助加辅助FLOT与改善OS的最佳方案概率最高相关。由于数据有限，无法确定DFS的明确排名。考虑非手术SAE，FLO已成为最安全的治疗方案。
本研究为临床医生为局部可切除胃癌患者选择围手术期治疗方案提供了有价值的见解。需要进一步研究来验证这些发现。
