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Abstract
Objective: A systematic review and meta-analysis was performed to investigate the efficacy of neoadjuvant chemotherapy for nonmetastatic esophago-gastric adenocarcinomas. Methods: Electronic databases were searched systematically from January 1980 to July 2012 and a total of 2,587 patients from 17 randomized controlled trials were subjected to meta-analysis. The odds ratios (ORs) for overall survival (OS) and progression-free survival (PFS) were calculated. Results: Seventeen randomized controlled trials were obtained and various comparisons of treatment approaches were performed.
Randomized controlled trials detected no differences in these comparisons:
R0 resection for neoadjuvant chemotherapy versus none;
Preoperative chemotherapy versus surgery alone: 3-year OS, 5-year OS, 5-year OS in Europe, 3-year PFS;
Preoperative chemotherapy plus postoperative chemotherapy versus postoperative chemotherapy: 1-year OS, 5-year OS;
Preoperative chemotherapy versus preoperative chemoradiotherapy: 3-year OS.
Randomized controlled trials detected significant differences in these comparisons:
Preoperative chemotherapy plus postoperative chemotherapy versus surgery alone: 3-year and 5-year PFS, 5-year OS;
Subgroup analysis examining preoperative chemotherapy versus surgery alone: 5-year OS in Asia;
Preoperative chemotherapy versus postoperative chemotherapy: 1-year OS.
Conclusion: The current limited evidence suggests that preoperative chemotherapy can be applied to patients with nonmetastatic esophago-gastric adenocarcinomas (specifically, advanced esophago-gastric cancer). However, the results should be interpreted with caution because of the statistically low power and the heterogeneity among study designs; therefore, our results need validations in future studies.