Cancer Res Treat.  2017 Jan;49(1):263-273. 10.4143/crt.2016.054.

Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials

• Chang SH
• Kim SN
• Choi HJ
• Park M
• Kim RB
• Go SI
• Lee WS

• KMID: 2367524
• DOI: http://doi.org/10.4143/crt.2016.054

Abstract

PURPOSE
This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies.
MATERIALS AND METHODS
PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model.
RESULTS
Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p(interaction)=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p(interaction)=0.846).
CONCLUSION
Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.

Keyword

Adjuvant chemotherapy; Aged; Stomach neoplasms; Meta-analysis

MeSH Terms

Aged*
Chemotherapy, Adjuvant*
Humans
Population Characteristics
Stomach Neoplasms*

Figure

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  Fig. 1. Flow diagram showing the study selection.

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  Fig. 2. Effects of adjuvant chemotherapy (CTX) for advanced gastric cancer on survival outcomes: overall survival (upper graph) and relapse-free survival (lower graph). Hazard ratios were analyzed using fixed effects model. Value 0-1 favors adjuvant chemotherapy. CI, confidence interval.

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  Fig. 3. Subgroup analysis of the effects of adjuvant chemotherapy (CTX) on overall survival by age: non-elderly (upper graph) versus elderly patients (lower graph). Hazard ratios were analyzed with fixed effects model. Value 0-1 favors adjuvant CTX. CI, confidence interval.

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  Fig. 4. Subgroup analysis of the adjuvant chemotherapeutic effects on relapse-free survival by ages: non-elderly (upper graph) versus elderly patients (lower graph). Hazard ratios were analyzed using fixed effects model. Value 0-1 favors adjuvant chemotherapy (CTX). CI, confidence interval.

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  Fig. 5. Toxic effects of adjuvant chemotherapy in terms of leukopenia (A), diarrhea (B), chemotherapy regimen-specific toxicities (C) (rash for S-1 in ACTS-GC study, and neuropathy for XELOX in CLASSIC study), thrombocytopenia (D), vomiting (E), and fatigue (F). Risk ratios were analyzed with random effects model. Value 0-1 favors adjuvant chemotherapy. CI, confidence interval; CTX, chemotherapy; XELOX, capecitabine plus oxaliplatin.

Reference

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