Adjuvant Chemotherapy vs. Surgery Alone for pT3N0M0 Gastric Cancer

Efficacy of Traditional Chinese Medicine Combined with Chemotherapy in the Treatment of Gastric Cancer: A Meta-analysis

Objective. Meta-analysis was conducted to explore the effects of CM combined with chemotherapy on the effective rate and survival rate of gastric cancer patients. Methods. Literature retrieval was performed in PubMed, MEDLINE, Embase, CENTRAL, and CNKI databases. The subject of the literature was to compare the efficacy of CM combined with chemotherapy and chemotherapy alone in patients with gastric cancer. According to the Cochrane manual, the risk of bias was assessed for inclusion in randomized controlled trials. The chi-square test was used for the heterogeneity test. Subgroup analysis and sensitivity analysis were used to explore the causes of heterogeneity. Funnel chart and Egger’s test were used to assess publication bias. Results. This study included 761 patients with gastric cancer from 10 literatures. The effective rate of chemotherapy in the CM combined group was higher than that in the chemotherapy alone group (odds ratio $\left(\text{OR}\right)=1.96$ , 95% confidence interval (CI) (1.39, 2.78), $Z=3.81$ , $P=0.0001$ ), and there was no heterogeneity among studies ( $\text{ch}{\text{i}}^2=5.68$ , $P=0.68$ , $I^2=0$ %). There was no significant publication bias among all studies ( $P>0.05$ ). The one-year survival rate in the CM combined group was higher than that in the chemotherapy alone group ( $\text{OR}=3.25$ , 95% CI (1.90, 5.54), $Z=4.32$ , $P<0.0001$ ). There was no heterogeneity among studies ( $\text{ch}{\text{i}}^2=1.04$ , $P=0.79$ , $I^2=0$ %) and no significant publication bias among studies ( $P>0.05$ ). The 3-year survival rate of gastric cancer patients in the traditional Chinese medicine combination group was higher than that in the chemotherapy alone group ( $\text{OR}=1.71$ , 95% CI (1.06, 2.78), $Z=2.18$ , $P=0.03$ ). There was no heterogeneity among studies ( $\text{ch}{\text{i}}^2=2.18$ , $P=0.54$ , $I^2=0$ %), and there was no significant publication bias ( $P>0.05$ ). The incidence of nausea and vomiting after chemotherapy in gastric cancer patients in the Chinese medicine combination group was lower than that in the chemotherapy alone group ( $\text{OR}=0.47$ , 95% CI (0.34, 0.64), $Z=4.80$ , $P<0.00001$ ). There was no heterogeneity among studies ( $\text{ch}{\text{i}}^2=8.57$ , $P=0.48$ , $I^2=0$ %), and there was no significant publication bias ( $P>0.05$ ). Conclusion. CM combined with chemotherapy can improve the effective rate and survival rate of gastric cancer and reduce the incidence of nausea and vomiting after chemotherapy. We recommend a large sample size, multicenter combined randomized controlled trial for validation.

Is Adjuvant Chemotherapy Beneficial to All Patients With pT3N0M0 Stage Gastric Cancer?

Background

The efficacy and benefits of adjuvant chemotherapy (AC) for patients with gastric cancer pT3N0M0 remain controversial.

Methods

We prospectively collected and retrospectively analyzed 235 patients with pT3N0M0 gastric cancer who underwent radical resection between February 2010 and January 2016. Patients were divided into two groups: the surgery-alone (SA) group (n = 82) and the AC group (n = 153). We analyzed the effects of AC on the overall survival (OS) and recurrence-free survival (RFS), and the relationship between the number of chemotherapy cycles (CC) and recurrence rate (RR).

Results

The 5-year OS and RFS of the participants were 80.9% and 87.7%, respectively, and those in the AC group were significantly higher than those in the SA group (86.9% vs. 69.5%, p = 0.003). The RFS of the AC and SA groups were 88.9% and 85.4%, respectively; the difference was not statistically significant (p = 0.35). The independent risk factors affecting the OS were perineural invasion-positive (PNI+) (HR = 2.64, 95%CI: 1.45-4.82, p = 0.003) and age ≥ 65 years (HR = 2.58, 95%CI: 1.39-4.8, p = 0.003). The independent risk factor affecting the RFS was also PNI+ (HR3.11; 95%CI: 1.48-6.54, p = 0.003). Stratified analysis revealed that postoperative AC can significantly improve the OS of PNI+ patients (AC group versus SA group: 84.1% vs. 45.5%, p = 0.001) and RFS (86.4% vs. 63.6%, p = 0.017). However, perineural invasion negative (PNI-) patients did not show the same results (p = 0.13 and p = 0.48, respectively). According to the number of CC, divided into CC < 3 groups and CC ≥ 3 groups, the cumulative RR in the CC ≥ 3 group of patients with PNI+ was significantly lower than that of the CC < 3 group (7.4% vs. 28.2%, p = 0.037).

Conclusion

For pT3N0M0 gastric cancer patients with PNI+, at least three cycles of postoperative AC can significantly reduce the overall RR. This finding should be verified by using large external sample data.

Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Purpose: Various adjuvant chemotherapies have been introduced for gastric cancer patients after gastrectomy with D2 lymph node dissection. Although the mainstream regimen of adjuvant chemotherapy in Korea includes S-1 monotherapy (TS-1) and capecitabine with oxaliplatin (XELOX), few studies have compared the long-term efficacies of these 2 regimens. Methods: Between January 2010 and June 2017, 2021 patients were diagnosed with gastric cancer and underwent curative resection with adjuvant chemotherapy at our institution. Of 1461 patients with stage IB-III gastric cancer, 825 received TS-1 and 636 received XELOX as adjuvant chemotherapy. We retrospectively reviewed their medical records and analyzed the postoperative 5-year overall survival (OS) and disease-free survival (DFS) of these 2 groups. Results: The patients in the XELOX group had more advanced stage of cancer than the TS-1 group (stages III and II: 56.6% and 43.1%, respectively, in XELOX and 35.3% and 57.0% in TS-1; P < .001). The DFS did not differ significantly between the 2 study groups at any pathologic stage. The OS differed significantly only at pathologic stages IIA (P = .024) and IIB (P = .015). In a multivariate analysis of stage II patients, type of regimen was an independent prognostic factor of OS (XELOX vs TS-1; hazard ratio: 0.47, 95% confidence interval: 0.25-0.89, P = .021). Conclusion: There were similar long-term efficacies between these 2 regimens in advanced gastric cancer patients who underwent curative surgery. However, the XELOX regimen might be favorable for OS of stage II patients.