What do systematic reviews say?

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy leads to lower overall survival by chemo‐/radiotherapy ‐ Chemotherapy only compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.83 [0.75, 0.91]
  10 studies · 2033 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy leads to lower overall survival among all patients compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.81 [0.73, 0.89]
  14 studies · 2422 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy showed no clear difference in presence of tumor‐free resection margin compared with primary surgery (moderate certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  OR 1.42 [0.97, 2.06]
  10 studies · 1665 participants
  Moderate

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy probably leads to higher tumor stage at resection (T0 to T2 vs T3 to T4) compared with primary surgery (moderate certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  OR 1.53 [1.02, 2.31]
  8 studies · 1410 participants
  Moderate

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy may leads to higher tumor stage at resection (N0 vs N+) compared with primary surgery (low certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  OR 2.43 [1.48, 3.99]
  8 studies · 1507 participants
  Low

Perioperative chemotherapy vs primary surgery

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  no estimate extracted
  9 studies · 1397 participants
  High

Perioperative chemotherapy vs primary surgery

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  no estimate extracted
  11 studies · 1606 participants
  Moderate

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy showed no clear difference in disease‐free survival (landmark time 6 months) compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.84 [0.69, 1.01]
  7 studies · 931 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy leads to lower overall survival by type of data ‐ Individual patient data compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.8 [0.66, 0.97]
  8 studies · 1049 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy probably leads to lower overall survival by type of data ‐ Aggregated data compared with primary surgery (moderate certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.81 [0.72, 0.92]
  6 studies · 1373 participants
  Moderate

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy showed no clear difference in overall survival by tumor site ‐ Esophagus compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.87 [0.73, 1.05]
  5 studies · 473 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy leads to lower overall survival by tumor site ‐ GE junction compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.69 [0.54, 0.87]
  6 studies · 470 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy showed no clear difference in overall survival by tumor site ‐ Stomach compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.94 [0.82, 1.06]
  7 studies · 828 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy probably leads to lower overall survival by chemo‐/radiotherapy ‐ Chemoradiotherapy compared with primary surgery (moderate certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.7 [0.5, 0.99]
  4 studies · 389 participants
  Moderate