Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: A meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente)

E. Mari, I. Floriani, A. Tinazzi, A. Buda, M. Belfiglio, M. Valentini, S. Cascinu, S. Barni, R. Labianca, V. Torri

Research output: Contribution to journalArticle

Abstract

Background: Several studies have investigated the possible role of the adjuvant chemotherapy after curative resection for gastric cancer failing to show a clear indication; previous meta-analyses suggested small survival benefit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. Materials and methods: Randomised trials were identified by means of Medline and CancerLit and by selecting references from relevant articles. Systematic review of all randomised clinical trials of adjuvant chemotherapy for gastric cancer compared with surgery alone, published before January 2000, were considered. Pooling of data was performed using the fixed effect model. Death for any cause was the study endpoint. The hazard ratio and its 95% confidence intervals (95% CI), derived according to the method of Parmar, were the statistics chosen for summarising the relative benefit of chemotherapy versus control. Results: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82, 95% CI: 0.75-0.89, P <0.001). Association of Anthracyclines to 5-FU did not show a statistically significant improvement when compared with the effect of the other regimens. Conclusions: Chemotherapy produces a small survival benefit in patients with curatively resected gastric cancer. However, taking into account the limitations of literature based meta-analyses, adjuvant chemotherapy is still to be considered as an investigational approach.

Original languageEnglish
Pages (from-to)837-843
Number of pages7
JournalAnnals of Oncology
Volume11
Issue number7
DOIs
Publication statusPublished - 2000

Fingerprint

Adjuvant Chemotherapy
Stomach Neoplasms
Meta-Analysis
Fluorouracil
Anthracyclines
Drug Therapy
Confidence Intervals
Survival
Combination Drug Therapy
Cause of Death
Randomized Controlled Trials

Keywords

  • Adjuvant
  • Chemotherapy
  • Gastric cancer
  • Meta-analysis
  • Randomised clinical trial

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Efficacy of adjuvant chemotherapy after curative resection for gastric cancer : A meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente). / Mari, E.; Floriani, I.; Tinazzi, A.; Buda, A.; Belfiglio, M.; Valentini, M.; Cascinu, S.; Barni, S.; Labianca, R.; Torri, V.

In: Annals of Oncology, Vol. 11, No. 7, 2000, p. 837-843.

Research output: Contribution to journalArticle

Mari, E. ; Floriani, I. ; Tinazzi, A. ; Buda, A. ; Belfiglio, M. ; Valentini, M. ; Cascinu, S. ; Barni, S. ; Labianca, R. ; Torri, V. / Efficacy of adjuvant chemotherapy after curative resection for gastric cancer : A meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente). In: Annals of Oncology. 2000 ; Vol. 11, No. 7. pp. 837-843.
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abstract = "Background: Several studies have investigated the possible role of the adjuvant chemotherapy after curative resection for gastric cancer failing to show a clear indication; previous meta-analyses suggested small survival benefit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. Materials and methods: Randomised trials were identified by means of Medline and CancerLit and by selecting references from relevant articles. Systematic review of all randomised clinical trials of adjuvant chemotherapy for gastric cancer compared with surgery alone, published before January 2000, were considered. Pooling of data was performed using the fixed effect model. Death for any cause was the study endpoint. The hazard ratio and its 95{\%} confidence intervals (95{\%} CI), derived according to the method of Parmar, were the statistics chosen for summarising the relative benefit of chemotherapy versus control. Results: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18{\%} (hazard ratio 0.82, 95{\%} CI: 0.75-0.89, P <0.001). Association of Anthracyclines to 5-FU did not show a statistically significant improvement when compared with the effect of the other regimens. Conclusions: Chemotherapy produces a small survival benefit in patients with curatively resected gastric cancer. However, taking into account the limitations of literature based meta-analyses, adjuvant chemotherapy is still to be considered as an investigational approach.",
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T1 - Efficacy of adjuvant chemotherapy after curative resection for gastric cancer

T2 - A meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente)

AU - Mari, E.

AU - Floriani, I.

AU - Tinazzi, A.

AU - Buda, A.

AU - Belfiglio, M.

AU - Valentini, M.

AU - Cascinu, S.

AU - Barni, S.

AU - Labianca, R.

AU - Torri, V.

PY - 2000

Y1 - 2000

N2 - Background: Several studies have investigated the possible role of the adjuvant chemotherapy after curative resection for gastric cancer failing to show a clear indication; previous meta-analyses suggested small survival benefit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. Materials and methods: Randomised trials were identified by means of Medline and CancerLit and by selecting references from relevant articles. Systematic review of all randomised clinical trials of adjuvant chemotherapy for gastric cancer compared with surgery alone, published before January 2000, were considered. Pooling of data was performed using the fixed effect model. Death for any cause was the study endpoint. The hazard ratio and its 95% confidence intervals (95% CI), derived according to the method of Parmar, were the statistics chosen for summarising the relative benefit of chemotherapy versus control. Results: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82, 95% CI: 0.75-0.89, P <0.001). Association of Anthracyclines to 5-FU did not show a statistically significant improvement when compared with the effect of the other regimens. Conclusions: Chemotherapy produces a small survival benefit in patients with curatively resected gastric cancer. However, taking into account the limitations of literature based meta-analyses, adjuvant chemotherapy is still to be considered as an investigational approach.

AB - Background: Several studies have investigated the possible role of the adjuvant chemotherapy after curative resection for gastric cancer failing to show a clear indication; previous meta-analyses suggested small survival benefit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. Materials and methods: Randomised trials were identified by means of Medline and CancerLit and by selecting references from relevant articles. Systematic review of all randomised clinical trials of adjuvant chemotherapy for gastric cancer compared with surgery alone, published before January 2000, were considered. Pooling of data was performed using the fixed effect model. Death for any cause was the study endpoint. The hazard ratio and its 95% confidence intervals (95% CI), derived according to the method of Parmar, were the statistics chosen for summarising the relative benefit of chemotherapy versus control. Results: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82, 95% CI: 0.75-0.89, P <0.001). Association of Anthracyclines to 5-FU did not show a statistically significant improvement when compared with the effect of the other regimens. Conclusions: Chemotherapy produces a small survival benefit in patients with curatively resected gastric cancer. However, taking into account the limitations of literature based meta-analyses, adjuvant chemotherapy is still to be considered as an investigational approach.

KW - Adjuvant

KW - Chemotherapy

KW - Gastric cancer

KW - Meta-analysis

KW - Randomised clinical trial

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