title: Chemotherapy for patients with gastric cancer after complete resection: a network meta-analysis.
abstract: OBJECTIVE
  To conduct a network meta-analysis to evaluate the effectiveness of different chemotherapy regimens for patients with gastric cancer.
  
  
  METHODS
  PubMed (1966-2011.12), the Cochrane Library (2011 Issue 2) and EMBASE (1974-2011.12) were searched with the terms "gastric cancer" and "chemotherapy", as well as the medical subject headings. References from relevant articles and conferences were also included. Patients who had previous gastric surgery, radiation before or after surgery or chemotherapy before surgery were excluded. In this study, only randomized controlled trials (RCTs) were considered, and the end-point was the overall mortality. Direct comparisons were performed using traditional meta-analysis whereas indirect comparisons were performed using network meta-analysis.
  
  
  RESULTS
  In total, 31 RCTs with 7120 patients were included. Five chemotherapy regimens, fluorouracil (FU) + BCNU, FU + methyl-CCNU (mCCNU), FU + cisplatin, FU + anthracyclines and FU + mitomycin c (MMC) + cytarabine (Ara-c), were found to be less beneficial in terms of overall mortality. In contrast, four chemotherapy regimens were effective for the patients after surgery, including FU + MMC + adriamycin (FMA), FU + MMC (FM), Tegafur and MMC, There was no significant difference in terms of overall mortality among these regimens. The evidence for the FM regimen and MMC regimen was poor. Additionally, the FMA regimen, which includes a variety of chemotherapy drugs and causes many side effects, was not better than the Tegafur regimen.
  
  
  CONCLUSIONS
  Although the four chemotherapy regimens were effective in patients with gastric cancer after surgery and the overall mortality revealed no significant difference among them in the network meta-analysis, thorough analysis of the results recommends Tegafur as the first-line adjuvant chemotherapy regimen for patients after complete resection.
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Ya-Wu
authors.initials: YW
authors.lastname: Zhang
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Zhang
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Pan
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Feng-Xian
authors.initials: FX
authors.lastname: Wei
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: You-Cheng
authors.initials: YC
authors.lastname: Zhang
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Hai-Peng
authors.initials: HP
authors.lastname: Liu
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Zhe-Yuan
authors.initials: ZY
authors.lastname: Wang
authors.affiliation: Ya-Wu Zhang, Yu-Long Zhang, Hui Pan, Feng-Xian Wei, You-Cheng Zhang, Yuan Shao, Wei Han, Hai-Peng Liu, Zhe-Yuan Wang, Sun-Hu Yang, Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
authors.forename: Sun-Hu
authors.initials: SH
authors.lastname: Yang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Chemotherapy; Gastric cancer; Indirect treatment comparison; Network meta-analysis; Randomized controlled trials