Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review
- Authors
- Rim, Chai Hong; Shin, In-Soo; Lee, Hye Yoon; Yoon, Won Sup; Park, Sunmin
- Issue Date
- 8월-2020
- Publisher
- MDPI
- Keywords
- D2 gastrectomy; stomach cancer; gastric cancer; chemoradiotherapy; radiation therapy
- Citation
- CANCERS, v.12, no.8
- Indexed
- SCIE
SCOPUS
- Journal Title
- CANCERS
- Volume
- 12
- Number
- 8
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/54234
- DOI
- 10.3390/cancers12082125
- ISSN
- 2072-6694
- Abstract
- Our study aimed to evaluate the benefits of chemoradiotherapy (CRT) after D2 gastrectomy, as compared to adjuvant chemotherapy, alone. PubMed, MEDLINE, Embase, and the Cochrane Library were systematically searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies, and all studies separately and in a hierarchical manner. Thirteen controlled studies, including six RCTs involving 2603 patients, were included. Overall pooled analysis revealed a disease-free survival benefit of CRT (odds ratio (OR): 1.264,p= 0.053), which was more evident in the subgroup analysis of RCTs (OR: 1.440,p= 0.006) and balanced studies (OR: 1.417,p< 0.001). Overall survival was insignificantly different in the overall pooled analysis (OR: 1.124,p= 0.347). However, the difference was marginally significant in the subgroup analysis of balanced studies (OR: 1.279,p= 0.055) and significant in the subgroup analysis of studies involving stage >= III patients only (OR: 1.663,p= 0.005). Locoregional recurrence (LRR) reduction was noted in the overall pooled analysis (OR: 0.559,p= 0.012; pooled rate: 11.3% vs. 18.1%) and was more robust in the subgroup analyses. Grade >= 3 leukopenia was higher in the CRT arm (OR: 1.387,p= 0.004; pooled rate: 26.4% vs. 15.7%). CRT after D2 gastrectomy should be applied for patients with high risk of LRR (e.g., stage >= III), along with efforts to reduce leukopenia.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.