palliative gastrectomy plus chemotherapy versus chemotherapy alone for incurable advanced gastric cancer: a meta-analysis

Pei Wu,1 Pengliang Wang,1 Bin Ma,2 Songcheng Yin,1 Yuen Tan,1 Wenbin Hou,1 Zhenning Wang,1 Huimian Xu,1 Zhi Zhu1 1Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang 110001, China; 2Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Dadong District, Shenyang 110042, Liaoning Province, China Background: Whether palliative gastrectomy combined with chemotherapy can improve the survival of patients with advanced gastric cancer remains controversial. We performed a meta-analysis to clarify whether palliative gastrectomy plus chemotherapy can benefit patients with incurable advanced gastric cancer and to explore the best candidates in this patient population. Methods: We searched the literature systematically using electronic databases including PubMed, EMBASE, and the Cochrane Library. And HRs and their 95% CIs were used to express the results for overall survival (OS) and progression-free survival (PFS). Results: One randomized controlled trial with 175 patients and 12 cohort studies with 2,193 patients were analyzed. The pooled HR for OS (HR=0.43, 95% CI=0.29–0.65, P<0.001), ­subgroup analysis of stage M1 (HR=0.53, 95% CI=0.40–0.72, P<0.001), peritoneal dissemination (HR=0.46, 95% CI=0.28–0.73, P=0.001), and liver metastasis (HR=0.46, 95% CI=0.33–0.65, P<0.001) all indicated the superiority of palliative gastrectomy plus chemotherapy. However, the pooled HR for PFS (HR=0.61, 95% CI=0.33–1.13, P=0.110) got separate outcome. Conclusion: The results of this meta-analysis indicated that palliative gastrectomy plus chemotherapy can improve OS for incurable advanced gastric cancer. In addition, analyses based on liver metastasis and peritoneal dissemination demonstrated the advantages of palliative gastrectomy plus chemotherapy. However, the PFS of incurable advanced gastric cancer with palliative gastrectomy plus chemotherapy was no better than that under chemotherapy alone. Keywords: advanced gastric cancer, palliative gastrectomy, chemotherapy, survival