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Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs).Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013),VIP (January 1989-June 2013),Chinese Biomedical Literature Database (January 1978-June 2013),Cochrane Library (Issue 6,2013),PubMed (January 1966-June 2013),and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer.The obtained data were analyzed using RevMan 5.2 and Stata 12.The difference between two groups was estimated by calculating the risk ratio (RR) with 95％ confidence interval (CI).Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria.Our results showed that postoperative chemoradiotherapy significantly increased 1-,2-,and 3-year overall survival rates (RR =1.20,95％ CI=1.10-1.30,P=0.00; RR =1.34,95％ CI=1.16-1.56,P=0.00; RR =2.62,95％ CI=1.72-3.97,P=0.00) and 3-and 5-year disease-free survival rates (RR =1.10,95 ％ CI =1.00-1.21,P =0.04; RR =1.27,95％ CI =1.02-1.60,P =0.04).The incidence of grade 3 or 4 gastrointestinal tract reactions,liver function impairment,bone marrow suppression,and hand-foot syndrome was low and showed little difference between two groups (P =0.03-0.78).Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer,and the patients have good tolerance to chemotherapy drugs.
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Objective To compare postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer by a meta-analysis.Methods PubMed,EMbase,Cochrane Library,Wanfang,CNKI,VIP,and CBM databases were searched to identify the controlled clinical trials of postoperative adjuvant chemoradiotherapy versus adjuvant chemotherapy for gastric cancer.The obtained data were analyzed using RevMan 5.2.5 and Stata 12.0.The difference between two groups was estimated by calculating the odds ratio (OR) with 95％ confidence interval (CI).Results A total of 12 controlled clinical trials involving 1674 gastric cancer patients,which were selected according to inclusion and exclusion criteria,were included in this meta-analysis.The meta-analysis showed that the 3-and 5-year survival rates were significantly higher in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR=2.96,95％ CI=1.75-5.03,P=0.000; OR=1.45,95％ CI=1.06-1.99,P =0.020);the local recurrence rate was significantly lower in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR =0.50,95％ CI =0.34-0.72,P =0.000) ; there was no significant difference in distant metastasis rate between the two groups (OR =0.79,95％ CI =0.58 -1.07,P =0.130).Conclusions The meta-analysis of existing study results shows that compared with adjuvant chemotherapy alone,adjuvant chemoradiotherapy is a relatively safe and effective postoperative treatment for gastric cancer.