Clinical relevance of meta-analysis of survival benefit when deciding treatment of adjuvant chemotherapy in gastric cancer.
The results of meta-analysis regarding survival benefit in adjuvant chemotherapy for gastric cancer are very useful and informative in clinical practice. However, in considering the current status of adjuvant therapy the following items regarding the effects of adjuvant therapy need to be considered: (i) the assessment of survival effect to adjuvant chemotherapy might differ due to the different lymph node dissection protocols practiced; (ii) the actual effect of adjuvant therapy on residual cancer cells cannot be monitored during treatment without evaluating long-term survival, although the effect of adjuvant therapy is dependent on the amount of residual cancer cells and their drug-sensitivity. The development of new regimens that include molecular targeted drugs may help to demonstrate a survival benefit of adjuvant chemotherapy. The studies collected for a meta-analysis are heterogeneous in their design and should not be thought of as providing estimates of a single quality. Since actual potential survival benefit of adjuvant chemotherapy most likely does exist, a large randomized controlled trial using new rationalized regimens based on standardized lymph node dissection is required for the establishment of survival benefit of adjuvant therapy in patients with advanced gastric cancer.
Kim
Ryungsa
R
Department of Surgical Oncology, International Radiation Information Center, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan. rkim@hiroshima-u.ac.jp
Toge
Tetsuya
T
D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy*