Comparative effectiveness of adjuvant treatments for resected gastric cancer: a network meta-analysis
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Different adjuvant treatments are available for patients with gastric cancer, but conventional meta-analyses performing direct comparisons between two alternative treatments did not have enough power to compare all the adjuvant treatments. Thus, we did a network meta-analysis summarizing the direct and indirect comparisons to identify the optimum treatment.
We systematically searched for RCTs of adjuvant treatments for gastric cancer comparing two or more of the following treatments: surgery alone, radiotherapy with fluoropyrimidine, S-1-based regimens, and XELOX. The treatments offering available indirect evidence to investigate the comparative effectiveness of adjuvant treatments mentioned above were also included. Then we performed a Bayesian network meta-analysis to summarize the direct and indirect comparisons. We estimated hazard ratios with 95% credible intervals (CrI) for OS and DFS.
11 eligible RCTs (5620 patients) were included in the network meta-analysis. Radiotherapy with fluorouracil (5-FU/RT), S-1-based regimens, and XELOX significantly improved OS as compared with surgery alone [(HR = 0.75 with 95% CrI: 0.63–0.89), (HR = 0.63 with 95% CrI: 0.52–0.76), and (HR = 0.66 with 95% CrI: 0.51–0.85), respectively]. No treatment was clearly superior to others; however, S-1-based regimes and XELOX showed a statistically non-significant trend to better survival as compared with 5-FU/RT.
S-1-based chemotherapy and XELOX are likely to be the most effective adjuvant treatments for patients with resected gastric cancer. 5-FU alone provided little survival benefits as compared with surgery alone. Further clinical trials may be required to investigate S-1-based and XELOX-based adjuvant treatment strategies.
KeywordsGastric cancer Adjuvant Chemotherapy Chemoradiotherapy, network meta-analysis
Bo Zhang, Zhaolun Cai, Yiqiong Yin designed the study. Jian Wang and Xiaonan Yin screened studies and extracted data. Disagreements were resolved by discussion with Yuan Yin. Zhaolun Cai did the statistical analyses and prepared figures. Bo Zhang, Zhixin Chen, Ye Zhou, Yuan Yin, Chaoyong Shen, Zhaolun Cai reviewed the results, interpreted data, and wrote the manuscript. All authors saw and approved the final version of the paper.
There was no sponsor for this study.
Compliance with Ethical Standards
Conflict of interest
The authors declare no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors.
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