The Efficacy and Safety of Perioperative Therapy for Resectable Locally Gastric Cancer: A Network Meta-Analysis of Randomized Clinical Trials

Abstract

Abstract Objective This study aimed to determine the optimal perioperative treatment regimen for locally resectable gastric cancer (GC). Methods A comprehensive literature search was conducted focusing on phase II/III randomized controlled trials (RCTs) assessing perioperative chemotherapy and chemoradiotherapy in locally resectable GC. The R0 resection rate, overall survival (OS), disease-free survival (DFS), and incidence of grade 3 or higher non-surgical adverse events (SAEs) associated with various perioperative regimens were analyzed. Bayesian network meta-analysis (NMA) was performed to compare the treatment regimens and rank their efficacy. Results A total of 30 RCTs involving 8346 patients were included in this study. Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared to surgery alone, and the former had the highest probability of being the most effective option in this context. Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for OS. Due to limited data, no definitive ranking could be determined for DFS. Considering non-surgical SAEs, FLO emerged as the safest regimen. Conclusions This study provides valuable insights for clinicians in selecting perioperative treatment regimens for locally resectable GC. However, further studies are needed to validate these findings.