Long-Term Outcomes of Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer/Esophagogastric Junction Cancer: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy (NAC) has been defined as any preoperative chemotherapy scheme aiming to reduce tumor staging and to control preoperative micrometastasis, which has been extensively used as a treatment for resectable gastric cancer. However, its effect on the long-term survival of patients with locally advanced gastric cancer (AGC) or esophagogastric junction cancer (EGC) remains unknown. OBJECTIVE: This study aimed at investigating the long-term efficacy of NAC in locally AGC/EGC. METHODS: The following databases were searched for articles published from their inception to April 2020 PubMed, Web of Science, EBSCO, and Cochrane library. The primary outcomes were overall survival (OS) and progression-free survival (PFS). RESULTS: A total of 19 articles were included in this meta-analysis, with a total of 4,446 patients. The results showed that NAC increased the patients' 3-year OS (HR 0.56, 95% CI, 0.21 - 0.91, p < 0.001), 3-year PFS (HR 0.76, 95% CI, 0.66 - 0.87, p < 0.001), 5-year OS (HR 0.71, 95% CI, 0.64 - 0.78, p < 0.001), and 5-year PFS (HR 0.70, 95% CI, 0.61 - 0.79, p < 0.001). Besides, subgroup analysis showed that Asian countries have benefited significantly from NAC (HR 0.65, 95% CI, 0.55 - 0.74, p < 0.001), and other countries have also benefited (HR 0.79, 95% CI, 0.68 - 0.89, p < 0.001). CONCLUSION: Compared with adjuvant chemotherapy and surgery alone, NAC can improve the long-term survival outcomes (OS and PFS) of patients with resectable AGC or EGC.