Cochrane · systematic review · CD008107
Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus
Ronellenfitsch, U, Schwarzbach, M, Hofheinz, R, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
GutAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
14
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 1 · 7.1%Moderate 5 · 35.7%High 8 · 57.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Perioperative chemotherapy compared to primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus
Population: resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival among all patients Perioperative chemotherapy vs primary surgery | HR 0.81 [0.73, 0.89] | 14 studies · 2422 participants | High |
Disease‐free survival (landmark time 6 months) Perioperative chemotherapy vs primary surgery | HR 0.84 [0.69, 1.01] | 7 studies · 931 participants | High |
Overall survival by type of data ‐ Individual patient data Perioperative chemotherapy vs primary surgery | HR 0.8 [0.66, 0.97] | 8 studies · 1049 participants | High |
Overall survival by type of data ‐ Aggregated data Perioperative chemotherapy vs primary surgery | HR 0.81 [0.72, 0.92] | 6 studies · 1373 participants | Moderate Downgraded: risk of bias |
Overall survival by tumor site ‐ Esophagus Perioperative chemotherapy vs primary surgery | HR 0.87 [0.73, 1.05] | 5 studies · 473 participants | High |
Overall survival by tumor site ‐ GE junction Perioperative chemotherapy vs primary surgery | HR 0.69 [0.54, 0.87] | 6 studies · 470 participants | High |
Overall survival by tumor site ‐ Stomach Perioperative chemotherapy vs primary surgery | HR 0.94 [0.82, 1.06] | 7 studies · 828 participants | High |
Perioperative chemotherapy compared to primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus
Population: resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival by chemo‐/radiotherapy ‐ Chemotherapy only Perioperative chemotherapy vs primary surgery | HR 0.83 [0.75, 0.91] | 10 studies · 2033 participants | High |
Overall survival by chemo‐/radiotherapy ‐ Chemoradiotherapy Perioperative chemotherapy vs primary surgery | HR 0.7 [0.5, 0.99] | 4 studies · 389 participants | Moderate Downgraded: inconsistency |
Presence of tumor‐free resection margin Perioperative chemotherapy vs primary surgery | OR 1.42 [0.97, 2.06] | 10 studies · 1665 participants | Moderate Downgraded: inconsistency |
Tumor stage at resection (T0 to T2 vs T3 to T4) Perioperative chemotherapy vs primary surgery | OR 1.53 [1.02, 2.31] | 8 studies · 1410 participants | Moderate Downgraded: inconsistency |
Tumor stage at resection (N0 vs N+) Perioperative chemotherapy vs primary surgery | OR 2.43 [1.48, 3.99] | 8 studies · 1507 participants | Low Downgraded: inconsistency, publication bias |
Postoperative morbidity RD Perioperative chemotherapy vs primary surgery | no estimate extracted | 9 studies · 1397 participants | High |
Postoperative mortality RD Perioperative chemotherapy vs primary surgery | no estimate extracted | 11 studies · 1606 participants | Moderate Downgraded: publication bias |