Localized stomach cancer: Perioperative or postoperative approach? A meta-analysis of phase III studies

Despite the development and standardization of surgical techniques in the treatment of localized gastric adenocarcinoma, the loco-regional and metastatic recurrence rate remains high. A combined radiochemotherapeutic regimen (the MacDonald regimen) as well as perioperative chemotherapy allows a significant improvement in the survival of patients with localized gastric adenocarcinoma with a reduction in the recurrence rate compared to surgery alone. The purpose of this review is to specify the best therapeutic approach in the treatment of localized gastric cancer.

We performed a systemic search of Medline, Embase, and the Cochrane Central Register of Controlled Trials using PubMed, Google Scholar, and Ovid without language restriction. Hazard ratio (HR) with 95% confidence interval (CI) was reported.

We pooled 727 patients from two phase III randomized controlled trials. There was a benefit of perioperative chemotherapy versus surgery alone on the overall survival (OS) (HR = 0.72, 95% CI: 0.55-0.95) and on disease free survival (DFS) (HR = 0.65, CI: 0.50-0.85). Adjuvant chemotherapy was superior to surgery alone based on OS and disease free survival (CLASSIC study HR = 0.72, CI: 0.52-1 and HR = 0.56, CI: 0.44-0.72, respectively). Adjuvant radiochemotherapy was superior to surgery alone (HR = 1.35, 95% CI: 1.09-1.66; P = 0.005).

A face-to-face comparison of perioperative chemotherapy versus adjuvant chemotherapy versus chemoradiotherapy is necessary.