Patients who have gastric cancer surgery followed by chemotherapy have an associated decreased risk of death and improved disease-free survival compared to patients who have surgery alone, according to a new French-led analysis of previous studies.
Researchers assessed the benefit of adjuvant chemotherapy quantitatively through a meta-analysis based on individual patient data from all relevant trials. For this analysis, the researchers identified 31 eligible trials (6,390 patients).
As of 2010, individual patient data were available from 17 trials (3,838 patients representing 60 per cent of the targeted data) with a median (midpoint) follow-up exceeding seven years.
There were 1,000 deaths among 1,924 patients assigned to chemotherapy groups and 1,067 deaths among 1,857 patients assigned to surgery-only groups. The researchers found that there was a significant benefit from any chemotherapy compared with surgery alone, with analysis indicating an overall 18 per cent reduction in the risk of death with chemotherapy. The estimated median overall survival was 4.9 years in the surgery-only group vs 7.8 years in the group receiving adjuvant chemotherapy.
An absolute improvement of about 6 per cent in overall survival was observed after five years, and maintained at ten years. Five-year overall survival increased from 49.6 per cent to 55.3 per cent with chemotherapy. Adjuvant chemotherapy was also associated with an 18 per cent reduction in the risk of relapse, compared with surgery alone.
“In conclusion, this patient-level meta-analysis shows that adjuvant fluorouracil-based chemotherapy, even in monotherapy, is associated with improvement in overall survival and is recommended for patients who have not received peri-operative treatments after complete resection of their gastric cancer. Future reports based on data being collected will explore prognostic factors and the surrogacy of disease-free survival for overall survival in this population,” the authors wrote.
JAMA 2010;303:1729-1737
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