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Abstract：
UNASSIGNED: This study aimed to evaluate the efficacy of multidisciplinary treatment for patients with locally advanced gastric cancer (LAGC) who underwent radical gastrectomy.
UNASSIGNED: Randomised controlled trials (RCTs) comparing the effectiveness of surgery alone, adjuvant chemotherapy (CT), adjuvant radiotherapy (RT), adjuvant chemoradiotherapy (CRT), neoadjuvant CT, neoadjuvant RT, neoadjuvant CRT, perioperative CT and hyperthermic intraperitoneal chemotherapy (HIPEC) for LAGC were searched. Overall survival (OS), disease-free survival (DFS), recurrence and metastasis, long-term mortality, adverse events (grade ≥3), operative complications and R0 resection rate were used as outcome indicators for meta-analysis.
UNASSIGNED: Forty-five RCTs with 10077 participants were finally analysed. Adjuvant CT had higher OS (hazard ratio [HR] = 0.74, 95% credible interval [CI] = 0.66-0.82) and DFS (HR = 0.67, 95% CI = 0.60-0.74) than surgery-alone group. Perioperative CT (odds ratio [OR] = 2.56, 95% CI = 1.19-5.50) and adjuvant CT (OR = 0.48, 95% CI = 0.27-0.86) both had more recurrence and metastasis than HIPEC + adjuvant CT, while adjuvant CRT tended to have less recurrence and metastasis than adjuvant CT (OR = 1.76, 95% CI = 1.29-2.42) and even adjuvant RT (OR = 1.83, 95% CI = 0.98-3.40). Moreover, the incidence of mortality in HIPEC + adjuvant CT was lower than that in adjuvant RT (OR = 0.28, 95% CI = 0.11-0.72), adjuvant CT (OR = 0.45, 95% CI = 0.23-0.86) and perioperative CT (OR = 2.39, 95% CI = 1.05-5.41). Analysis of adverse events (grade ≥3) showed no statistically significant difference between any two adjuvant therapy groups.
UNASSIGNED: A combination of HIPEC with adjuvant CT seems to be the most effective adjuvant therapy, which contributes to reducing tumour recurrence, metastasis and mortality - without increasing surgical complications and adverse events related to toxicity. Compared with CT or RT alone, CRT can reduce recurrence, metastasis and mortality but increase adverse events. Moreover, neoadjuvant therapy can effectively improve the radical resection rate, but neoadjuvant CT tends to increase surgical complications.
UNASSIGNED: Randomised controlled trials (RCTs) comparing the effectiveness of surgery alone, adjuvant chemotherapy (CT), adjuvant radiotherapy (RT), adjuvant chemoradiotherapy (CRT), neoadjuvant CT, neoadjuvant RT, neoadjuvant CRT, perioperative CT and hyperthermic intraperitoneal chemotherapy (HIPEC) for LAGC were searched. Overall survival (OS), disease-free survival (DFS), recurrence and metastasis, long-term mortality, adverse events (grade ≥3), operative complications and R0 resection rate were used as outcome indicators for meta-analysis.
UNASSIGNED: Forty-five RCTs with 10077 participants were finally analysed. Adjuvant CT had higher OS (hazard ratio [HR] = 0.74, 95% credible interval [CI] = 0.66-0.82) and DFS (HR = 0.67, 95% CI = 0.60-0.74) than surgery-alone group. Perioperative CT (odds ratio [OR] = 2.56, 95% CI = 1.19-5.50) and adjuvant CT (OR = 0.48, 95% CI = 0.27-0.86) both had more recurrence and metastasis than HIPEC + adjuvant CT, while adjuvant CRT tended to have less recurrence and metastasis than adjuvant CT (OR = 1.76, 95% CI = 1.29-2.42) and even adjuvant RT (OR = 1.83, 95% CI = 0.98-3.40). Moreover, the incidence of mortality in HIPEC + adjuvant CT was lower than that in adjuvant RT (OR = 0.28, 95% CI = 0.11-0.72), adjuvant CT (OR = 0.45, 95% CI = 0.23-0.86) and perioperative CT (OR = 2.39, 95% CI = 1.05-5.41). Analysis of adverse events (grade ≥3) showed no statistically significant difference between any two adjuvant therapy groups.
UNASSIGNED: A combination of HIPEC with adjuvant CT seems to be the most effective adjuvant therapy, which contributes to reducing tumour recurrence, metastasis and mortality - without increasing surgical complications and adverse events related to toxicity. Compared with CT or RT alone, CRT can reduce recurrence, metastasis and mortality but increase adverse events. Moreover, neoadjuvant therapy can effectively improve the radical resection rate, but neoadjuvant CT tends to increase surgical complications.
摘要：
■本研究旨在评估多学科治疗对接受根治性胃切除术的局部晚期胃癌（LAGC）患者的疗效。
■比较单独手术效果的随机对照试验(RCT),辅助化疗（CT），辅助放疗（RT），辅助放化疗（CRT），新辅助CT,新辅助RT,新辅助CRT,对LAGC的围手术期CT和腹腔热化疗（HIPEC）进行了搜索。总生存期（OS），无病生存率（DFS），复发和转移，长期死亡率，不良事件（≥3级），手术并发症和R0切除率作为Meta分析的结果指标。
■最终分析了45个RCT，共10077名参与者。辅助CT的OS（风险比[HR]=0.74，95%可信区间[CI]=0.66-0.82）和DFS（HR=0.67，95%CI=0.60-0.74）高于单独手术组。围手术期CT（比值比[OR]=2.56，95％CI=1.19-5.50）和辅助CT（OR=0.48，95％CI=0.27-0.86）均比HIPEC辅助CT具有更多的复发和转移，而辅助CRT的复发和转移倾向于比辅助CT（OR=1.76，95％CI=1.29-2.42）和甚至辅助RT（OR=1.83，95％CI=0.98-3.40）更少。此外，HIPEC+辅助CT的死亡率低于辅助RT（OR=0.28，95％CI=0.11-0.72），辅助CT(OR=0.45,95%CI=0.23-0.86)和围手术期CT(OR=2.39,95%CI=1.05-5.41)。不良事件（≥3级）分析显示，任何两个辅助治疗组之间均无统计学差异。
■HIPEC与辅助CT的组合似乎是最有效的辅助疗法，这有助于减少肿瘤复发，转移和死亡率-没有增加与毒性相关的手术并发症和不良事件。与单纯CT或RT相比，CRT可以减少复发，转移和死亡率，但增加不良事件。此外，新辅助治疗能有效提高根治性切除率,但新辅助CT往往会增加手术并发症。
■比较单独手术效果的随机对照试验(RCT),辅助化疗（CT），辅助放疗（RT），辅助放化疗（CRT），新辅助CT,新辅助RT,新辅助CRT,对LAGC的围手术期CT和腹腔热化疗（HIPEC）进行了搜索。总生存期（OS），无病生存率（DFS），复发和转移，长期死亡率，不良事件（≥3级），手术并发症和R0切除率作为Meta分析的结果指标。
■最终分析了45个RCT，共10077名参与者。辅助CT的OS（风险比[HR]=0.74，95%可信区间[CI]=0.66-0.82）和DFS（HR=0.67，95%CI=0.60-0.74）高于单独手术组。围手术期CT（比值比[OR]=2.56，95％CI=1.19-5.50）和辅助CT（OR=0.48，95％CI=0.27-0.86）均比HIPEC辅助CT具有更多的复发和转移，而辅助CRT的复发和转移倾向于比辅助CT（OR=1.76，95％CI=1.29-2.42）和甚至辅助RT（OR=1.83，95％CI=0.98-3.40）更少。此外，HIPEC+辅助CT的死亡率低于辅助RT（OR=0.28，95％CI=0.11-0.72），辅助CT(OR=0.45,95%CI=0.23-0.86)和围手术期CT(OR=2.39,95%CI=1.05-5.41)。不良事件（≥3级）分析显示，任何两个辅助治疗组之间均无统计学差异。
■HIPEC与辅助CT的组合似乎是最有效的辅助疗法，这有助于减少肿瘤复发，转移和死亡率-没有增加与毒性相关的手术并发症和不良事件。与单纯CT或RT相比，CRT可以减少复发，转移和死亡率，但增加不良事件。此外，新辅助治疗能有效提高根治性切除率,但新辅助CT往往会增加手术并发症。
