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)

Background: Several studies have investigated the possible role of the adju vant chemotherapy after curative resection for gastric cancer failing to sh ow a clear indication; previous meta-analyses suggested small survival bene fit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. Materials and methods. Randomised trials were identified by means of Medlin e and CancerLit and by selecting references from relevant articles. Systema tic review of all randomised clinical trials of adjuvant chemotherapy for g astric cancer compared with surgery alone, published before January 2000, w ere 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% c onfidence intervals (95% CI), derived according to the method of Parmar, we re the statistics chosen for summarising the relative benefit of chemothera py versus control. Results: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluor ouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyc lines. 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 wit h curatively resected gastric cancer. However, taking into account the limi tations of literature based meta-analyses, adjuvant chemotherapy is still t o be considered as an investigational approach.