Survival Benefit of Neoadjuvant Chemotherapy for Resectable Cancer of the Gastric and Gastroesophageal Junction A Meta-Analysis

Background: The objective of the present meta-analysis was to estimate the magnitude of survival benefits of neoadjuvant chemotherapy (NAT) in resectable cancer of the gastric and gastroesophageal junction. Materials and Methods: We searched PubMed, Embase, the Cochrane Library, ISI Web of Knowledge, Chinese biomedical literature database, Chinese Scientific Journals full-text database of retrieved articles from their inception to 2013. Two reviewers independently retrieved study and data extraction of included studies. Results regarding the overall survival and progression-free survival in the meta-analysis were expressed as hazard ratios (HRs) with 95% confidence intervals (CI). Results: Twelve randomized control trials (n= 1755) were eligible for final meta-analysis. NAT was associated with a statistically significant benefit in terms of overall survival (HR= 0.72; 95% CI, 0.56-0.93, P= 0.01), progression-free survival (HR= 0.73; 95% CI, 0.62-0.87, P= 0.0003), 5-year survival rate [ relative risk (RR)= 1.36; 95% CI, 1.10-1.67, P= 0.0004], and curative resection rate (RR= 1.11; 95% CI, 1.03-1.20, P= 0.009). Five-year survival rate increased from 30% to 42% with NAT. No significant difference with regards to overall postoperative complications rate (RR= 1.08; 95% CI, 0.92-1.27, P= 0.28) was found between 2 groups. Conclusion: There is convincing evidence for a survival benefit of NAT over surgery alone in patient with cancer of the gastric and gastroesophageal junction.