title: Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis.
abstract: BACKGROUND
  Despite potentially curative resection of stomach cancer, 50% to 90% of patients die of disease relapse. Numerous randomized clinical trials (RCTs) have compared surgery alone with adjuvant chemotherapy, but definitive evidence is lacking.
  
  
  OBJECTIVE
  To perform an individual patient-level meta-analysis of all RCTs to quantify the potential benefit of chemotherapy after complete resection over surgery alone in terms of overall survival and disease-free survival, and to further study the role of regimens, including monochemotherapy; combined chemotherapy with fluorouracil derivatives, mitomycin C, and other therapies but no anthracyclines; combined chemotherapy with fluorouracil derivatives, mitomycin C, and anthracyclines; and other treatments.
  
  
  METHODS
  Data from all RCTs comparing adjuvant chemotherapy with surgery alone in patients with resectable gastric cancer. We searched MEDLINE (up to 2009), the Cochrane Central Register of Controlled Trials, the National Institutes of Health trial registry, and published proceedings from major oncologic and gastrointestinal cancer meetings.
  
  
  METHODS
  All RCTs closed to patient recruitment before 2004 were eligible. Trials testing radiotherapy; neoadjuvant, perioperative, or intraperitoneal chemotherapy; or immunotherapy were excluded. Thirty-one eligible trials (6390 patients) were identified.
  
  
  METHODS
  As of 2010, individual patient data were available from 17 trials (3838 patients representing 60% of the targeted data) with a median follow-up exceeding 7 years.
  
  
  RESULTS
  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 (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.76-0.90; P < .001) and disease-free survival (HR, 0.82; 95% CI, 0.75-0.90; P < .001). There was no significant heterogeneity for overall survival across RCTs (P = .52) or the 4 regimen groups (P = .13). Five-year overall survival increased from 49.6% to 55.3% with chemotherapy.
  
  
  CONCLUSIONS
  Among the RCTs included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone.
authors.forename: Xavier
authors.initials: X
authors.lastname: Paoletti
authors.forename: Koji
authors.initials: K
authors.lastname: Oba
authors.forename: Tomasz
authors.initials: T
authors.lastname: Burzykowski
authors.forename: Stefan
authors.initials: S
authors.lastname: Michiels
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pignon
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
authors.forename: Junichi
authors.initials: J
authors.lastname: Sakamoto
authors.forename: Daniel
authors.initials: D
authors.lastname: Sargent
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.forename: Marc
authors.initials: M
authors.lastname: Buyse
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents