Gustavo Tadeu Freitas Uchôa Matheus, Pedro Henrique de Souza Wagner, João Arthur Cerqueira Taumaturgo, Shi Juin Lam, Francisco Cezar Aquino de Moraes
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引用次数: 0
Abstract
Background: Gastric (GC) and gastroesophageal junction (GEJ) cancers are among the most prevalent digestive cancers, characterized by a poor prognosis, particularly in advanced stages, where the 5-year survival rate remains below 20%. While surgery is still the standard treatment, its limited ability to lower recurrence rates highlights the necessity for effective perioperative therapies. In this context, Radiotherapy (RT) and chemoradiotherapy (CRT) have been investigated for their potential to improve tumor control, pathologic complete response (pCR), and overall survival (OS) in advanced GC. This systematic review and meta-analysis aimed to assess the efficacy and safety of preoperative RT/CRT on key clinical outcomes in patients with GC, focusing on pathologic complete response (pCR), overall survival (OS), and postoperative complications, such as anastomotic leaks and postoperative mortality.
Methods: A systematic search of PubMed, Embase, and Web of Science databases was conducted for randomized controlled trials and single-arm studies comparing preoperative RT/CRT with chemotherapy or surgery alone. Outcomes were pooled using risk ratios (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs), and heterogeneity was assessed using I2 statistics. Furthermore, quality assessment was performed using RoB 2 and ROBINS-I tools. We also utilized tools to enhance the interpretation and understanding of the meta-analysis results, including GRADE, the leave-one-out method, Baujat and Doi plots.
Results: Ten studies including 6 RCTs and 4 single-arm studies, comprising 2,138 patients were included. CRT significantly improved pCR rates compared to control groups (RR 2.72; 95% CI 1.89-3.92; p < 0.000001; I2 = 0%), with a pCR rate of 21% in single-arm analysis. No statistical significance was observed in the hazard ratio analysis for OS (HR 0.84; 95% CI 0.65-1.10; p = 0.209; I2 = 67%), including the subgroup analyses at three (RR 1.15; 95% CI 0.93-1.43; p = 0.183; I2 = 70%) and five years (RR 1.23; 95% CI 1.00-1.51; p = 0.051; I2 = 58%). Moreover, the rates for anastomotic leaks (RR 0.86; 95% CI 0.66-1.14; p = 0.294; I2 = 0%) and postoperative mortality (RR 0.88; 95% CI 0.46-1.70; p = 0.71; I2 = 25%) showed no significant differences between groups, with low event rates in single-arm studies, 7% and 3%, respectively.
Conclusion: Preoperative CRT significantly improves pCR rates, highlighting its potential as a valuable strategy in tumor downstaging. However, it does not enhance survival outcomes, while notably, it does not increase surgical complications. Future studies incorporating biomarkers and standardized protocols are essential to refine patient selection, ensuring optimized treatment strategies and maximizing clinical benefits.
期刊介绍:
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.