论文部分内容阅读
Objective To assess the efficacy and safety of neoadjuvant chemotherapy (NAC) for advanced gastric cancer (AGC).Methods By searching electronic databases (PubMed, Embase, Cochrane Library) and ASCO proceedings from1990 to 2012, all randomized controlled trials (RCTs) which compared the effect of NAC combined surgery versus surgery alone in gastric cancer would be included.All calculations and statistical tests were performed using RevMan 5.0 software.Results 12 RCTs with a total of 1820 patients were included.All patients had locally advanced but resectable gastric cancer and received NAC.NAC can slightly improve the survival rate [OR =1.32, 95% confidence interval (CI): 1.07-1.64, P=0.01], little or no significant benefits were suggested in subgroup analyses between different population and regimens either.It can significantly improved the 3-year progression-free survival (PFS) [OR: 1.85,(1.39, 2.46), P <0.0001], tumor down-staging rate [OR :1.71,(1.26, 2.33), P =0.0006]and R0 resection rate[OR: 1.38,(1.08, 1.78) P=0.01] of patients with advanced gastric cancer.There were no difference between the two arms,in terms of relapse rates [OR: 1.03, (0.60, 1.78), P=0.92], operative complications[OR: 1.20,(0.90, 1.58), P=0.21], perioperative mortality [OR: 1.14, (0.64, 2.05), P=0.65] and grade 3/4 adverse effects.Conclusion NAC is effective and safe.It needs further prospective multinational multicenter RCTs to define the clinical benefits of NAC and the most effective strategies for AGC.