title: S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer: a meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy and tolerability of S-1-based vs non-S-1-based chemotherapy in advanced gastric cancer (AGC).
  
  
  METHODS
  We extracted reported endpoints, including overall survival (OS), progression-free survival (PFS), time-to-treatment failure (TTF), objective response rate (ORR) and adverse effects, from randomized controlled trials identified in PubMed, the Cochrane library, Science Direct, EMBASE and American Society of Clinical Oncology meetings. Stata software was used to calculate the pooled values.
  
  
  RESULTS
  Seven randomized controlled trials involving 2176 patients were included in this meta-analysis. Compared to non-S-1-based regimens, the use of S-1-based regimens were associated with an increase in ORR (RR = 1.300; 95%CI: 1.028-1.645); OS (HR = 0.89; 95%CI: 0.81-0.99; P = 0.025), TTF (HR = 0.83; 95%CI: 0.75-0.92; P = 0.000), and a lower risk of febrile neutropenia (RR = 0.225; P = 0.000) and stomatitis (RR = 0.230; P = 0.032). OS, PFS and TTF were prolonged, especially in the Asian population. In subgroup analysis, statistically significant increases in ORR (RR = 1.454; P = 0.029), OS (HR = 0.895; P = 0.041) and TTF (HR = 0.832; P = 0.000) were found when S-1-based chemotherapy was compared to 5-fluorouracil (5-FU)-based chemotherapy. The incidence of leukopenia (RR = 0.584; P = 0.002) and stomatitis (RR = 0.230; P = 0.032) was higher in the 5-FU-based arm. S-1-based regimens had no advantage in ORR, OS, PFS, TTF and grade 3 or 4 adverse events over capecitabine-based regimens.
  
  
  CONCLUSIONS
  S-1-based chemotherapy may be a good choice for AGC because of longer survival times, better tolerance and more convenient use.
authors.affiliation: Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Min
authors.affiliation: Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yao
authors.affiliation: Jian Yang, Yan Zhou, Ke Min, Qiang Yao, Chun-Ni Xu, Department of Oncology, Affiliated Yixing People's Hospital, Jiangsu University, Wuxi 214200, Jiangsu Province, China.
authors.forename: Chun-Ni
authors.initials: CN
authors.lastname: Xu
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D004338:Drug Combinations; D006801:Humans; D010094:Oxonic Acid / Q000008:administration & dosage; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D005641:Tegafur / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid
keywords: Advanced gastric cancer; Chemotherapy; First line treatment; Meta-analysis; S-1