Despite potentially curative resection of stomach cancer, 50% to 90% of patients die of disease relapse.
Numerous randomized clinical trials have compared surgery alone with adjuvant chemotherapy, but definitive evidence is lacking.
Dr Xavier Paoletti and colleagues from France performed an individual patient-level meta-analysis of all randomized clinical trials to quantify the potential benefit of chemotherapy after complete resection over surgery alone in terms of overall survival and disease-free survival.
The researchers further studied the role of regimens, including monochemotherapy; combined chemotherapy with fluorouracil derivatives, mitomycin C, and other therapies but no anthracyclines.
In addition, the team evaluated the combined chemotherapy with fluorouracil derivatives, mitomycin C, and anthracyclines, and other treatments.
Data was used from all randomized clinical trials comparing adjuvant chemotherapy with surgery alone in patients with resectable gastric cancer.
The research team searched MEDLINE, the Cochrane Central Register of Controlled Trials, the National Institutes of Health trial registry, and published proceedings from major oncologic and gastrointestinal cancer meetings.
The team identified 31 eligible randomized clinical trials including 6390 patients up to 2004.
|5 year overall survival increased from 50% to 55% with chemotherapy|
|Journal of the American Medical Association|
Trials testing radiotherapy, neoadjuvant, perioperative, or intraperitoneal chemotherapy, or immunotherapy were excluded.
As of 2010, individual patient data were available from 17 trials with a median follow-up exceeding 7 years.
There were 1000 deaths among 1924 patients assigned to chemotherapy groups and 1067 deaths among 1857 patients assigned to surgery-only groups.
Adjuvant chemotherapy was associated with a statistically significant benefit in terms of overall survival and disease-free survival.
The researchers found no significant heterogeneity for overall survival across randomized clinical trials or the 4 regimen groups, and 5 year overall survival increased from 50% to 55% with chemotherapy.
Dr Paolett's team concluded, "Among the randomized clinical trials included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone."