Neoadjuvant chemotherapy brings more survival benefits than postoperative chemotherapy for resectable gastric cancer: a Meta-analysis of randomized controlled trials.

PURPOSE: To find out which treatment, neoadjuvant chemotherapy (NAC) or postoperative chemotherapy (PAC), can bring greater survival benefits to gastric cancer patients. METHODS: Pubmed, Embase and Cochrane Library databases were searched for randomized controlled trials （RCTs）about multidisciplinary treatment of resectable gastric cancer (NAC vs PAC, NAC + surgery vs surgery alone, and surgery alone vs surgery + PAC). Quality was assessed by collaboration recommendation in Cochrane. All outcomes were evaluated by odds ratio (OR) and 95% confidence interval (CI). Pairwise comparisons were conducted by R3.12 software. Aggregate Data Drug Information System (ADDIS software 1.16.5) was used to perform network meta-analysis. RESULTS: Simple meta-analysis showed NAC could bring more survival benefits than PAC for resectable gastric cancer. NAC was significantly better than PAC in 1-year (I2=0, p=0.4085, fixed effects model, OR=2.28, 95%CI: 1.27-4.04), 3-year (I2=0,p=0.6979，fixed effects model, OR=2.10, 95%CI: 1.09-4.03), and 5-year survival (I2=37.8%, p=0.2048，fixed effects model, OR=2.04, 95%CI: 1.03-4.06). Network meta-analysis showed NAC + surgery was better compared with surgery + PAC and surgery alone. NAC + surgery were significantly better than surgery + PAC and surgery alone in 1-year or 3-year survival. For 5-year survival, NAC + surgery were significantly better than surgery alone, but no significant difference was observed when compared with surgery + PAC. NAC + surgery ranked first in 1-year, 3-year and 5-year probability sequence diagram. CONCLUSION: NAC brings greater survival benefits than PAC for patients with resectable gastric cancer.