Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
Identifieur interne : 004D30 ( Main/Curation ); précédent : 004D29; suivant : 004D31Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
Auteurs : Ulrich Ronellenfitsch [Allemagne] ; Matthias Schwarzbach [Allemagne] ; Ralf Hofheinz [Allemagne] ; Peter Kienle [Allemagne] ; Meinhard Kieser [Allemagne] ; Tracy E. Slanger [Allemagne] ; Bryan Burmeister [Australie] ; David Kelsen [États-Unis] ; Donna Niedzwiecki [États-Unis] ; Christoph Schuhmacher [Allemagne] ; Susan Urba [États-Unis] ; Cornelis Van De Velde [Pays-Bas] ; Thomas N. Walsh [Irlande (pays)] ; Marc Ychou [France] ; Katrin Jensen [Allemagne]Source :
- European journal of cancer : (1990) [ 0959-8049 ] ; 2013.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
Abstract
Background: The prognosis of patients with gastroesophageal adenocarcinoma is poor. There is conflicting evidence regarding effects of preoperative chemotherapy on survival and other outcomes. Methods: We conducted a meta-analysis with aggregate and individual patient data (IPD) to assess the effect of preoperative chemotherapy for gastroesophageal adenocarcinoma on survival and other outcomes. Two independent reviewers identified eligible randomised controlled trials (RCTs) comparing chemotherapy+/-radiotherapy followed by surgery with surgery alone for gastroesophageal adenocarcinoma. IPD was solicited from all trials. Meta-analyses were performed using the two stage method. Results: We identified 14 RCTs (2422 patients). For eight RCTs (1049 patients; 43.3%) we obtained IPD. Preoperative chemotherapy was associated with longer overall survival (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.73-0.89; p < 0.0001). There were larger treatment effects in tumours of the gastroesophageal junction and for chemoradiotherapy compared to chemotherapy, but the tests for subgroup differences were not statistically significant. Preoperative chemotherapy was associated with longer disease-free survival, higher likelihood of R0 resection and more favourable post-treatment tumour stage, but not perioperative complications. Conclusion: Preoperative chemotherapy for locoregional gastroesophageal adenocarcinoma increases survival compared to surgery alone. It should be offered to all eligible patients. There appear to be larger survival advantages in tumours of the gastroesophageal junction and for chemoradiotherapy, but these findings require prospective confirmation.
Links toward previous steps (curation, corpus...)
- to stream PascalFrancis, to step Corpus: Pour aller vers cette notice dans l'étape Curation :000776
- to stream PascalFrancis, to step Curation: Pour aller vers cette notice dans l'étape Curation :005713
- to stream PascalFrancis, to step Checkpoint: Pour aller vers cette notice dans l'étape Curation :000706
- to stream Main, to step Merge: Pour aller vers cette notice dans l'étape Curation :004E80
Links to Exploration step
Pascal:13-0329031Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data</title><author><name sortKey="Ronellenfitsch, Ulrich" sort="Ronellenfitsch, Ulrich" uniqKey="Ronellenfitsch U" first="Ulrich" last="Ronellenfitsch">Ulrich Ronellenfitsch</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Schwarzbach, Matthias" sort="Schwarzbach, Matthias" uniqKey="Schwarzbach M" first="Matthias" last="Schwarzbach">Matthias Schwarzbach</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst</s1><s2>Frankfurt</s2><s3>DEU</s3><sZ>2 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Hofheinz, Ralf" sort="Hofheinz, Ralf" uniqKey="Hofheinz R" first="Ralf" last="Hofheinz">Ralf Hofheinz</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Day Treatment Center (TTZ), Interdisciplinary Tumor Center Mannheim (ITM) and 3rd Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>3 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Kienle, Peter" sort="Kienle, Peter" uniqKey="Kienle P" first="Peter" last="Kienle">Peter Kienle</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Kieser, Meinhard" sort="Kieser, Meinhard" uniqKey="Kieser M" first="Meinhard" last="Kieser">Meinhard Kieser</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Institute of Medical Biometry and Informatics, University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Slanger, Tracy E" sort="Slanger, Tracy E" uniqKey="Slanger T" first="Tracy E." last="Slanger">Tracy E. Slanger</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Institute for Quality and Efficiency in Health Care (IQWiG)</s1><s2>Cologne</s2><s3>DEU</s3><sZ>6 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Institute for Quality and Efficiency in Health Care (IQWiG)</wicri:noRegion><wicri:noRegion>Institute for Quality and Efficiency in Health Care (IQWiG)</wicri:noRegion></affiliation></author><author><name sortKey="Burmeister, Bryan" sort="Burmeister, Bryan" uniqKey="Burmeister B" first="Bryan" last="Burmeister">Bryan Burmeister</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Queensland, Princess Alexandra Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Kelsen, David" sort="Kelsen, David" uniqKey="Kelsen D" first="David" last="Kelsen">David Kelsen</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College</s1><s2>New York, NY</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College</wicri:noRegion></affiliation></author><author><name sortKey="Niedzwiecki, Donna" sort="Niedzwiecki, Donna" uniqKey="Niedzwiecki D" first="Donna" last="Niedzwiecki">Donna Niedzwiecki</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Cancer and Leukemia Group B Statistical Center, Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Durham, NC</wicri:noRegion></affiliation></author><author><name sortKey="Schuhmacher, Christoph" sort="Schuhmacher, Christoph" uniqKey="Schuhmacher C" first="Christoph" last="Schuhmacher">Christoph Schuhmacher</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>Department of Surgery, Klinikum rechts der Isar, Technische Universität München</s1><s2>Munich</s2><s3>DEU</s3><sZ>10 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Urba, Susan" sort="Urba, Susan" uniqKey="Urba S" first="Susan" last="Urba">Susan Urba</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Division of Hematology/Oncology, University of Michigan Medical Center</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor, MI</wicri:noRegion></affiliation></author><author><name sortKey="Van De Velde, Cornelis" sort="Van De Velde, Cornelis" uniqKey="Van De Velde C" first="Cornelis" last="Van De Velde">Cornelis Van De Velde</name><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Department of Surgery, Leiden University Medical Center</s1><s2>Leiden</s2><s3>NLD</s3><sZ>12 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Walsh, Thomas N" sort="Walsh, Thomas N" uniqKey="Walsh T" first="Thomas N." last="Walsh">Thomas N. Walsh</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Department of Surgery, Connolly Hospital Blanchardstown</s1><s2>Dublin</s2><s3>IRL</s3><sZ>13 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Ychou, Marc" sort="Ychou, Marc" uniqKey="Ychou M" first="Marc" last="Ychou">Marc Ychou</name><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Centre Regional de Lutte Contre le Cancer</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Jensen, Katrin" sort="Jensen, Katrin" uniqKey="Jensen K" first="Katrin" last="Jensen">Katrin Jensen</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Institute of Medical Biometry and Informatics, University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0329031</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0329031 INIST</idno><idno type="RBID">Pascal:13-0329031</idno><idno type="wicri:Area/PascalFrancis/Corpus">000776</idno><idno type="wicri:Area/PascalFrancis/Curation">005713</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000706</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000706</idno><idno type="wicri:doubleKey">0959-8049:2013:Ronellenfitsch U:preoperative:chemo:radio</idno><idno type="wicri:Area/Main/Merge">004E80</idno><idno type="wicri:Area/Main/Curation">004D30</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data</title><author><name sortKey="Ronellenfitsch, Ulrich" sort="Ronellenfitsch, Ulrich" uniqKey="Ronellenfitsch U" first="Ulrich" last="Ronellenfitsch">Ulrich Ronellenfitsch</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Schwarzbach, Matthias" sort="Schwarzbach, Matthias" uniqKey="Schwarzbach M" first="Matthias" last="Schwarzbach">Matthias Schwarzbach</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst</s1><s2>Frankfurt</s2><s3>DEU</s3><sZ>2 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Hofheinz, Ralf" sort="Hofheinz, Ralf" uniqKey="Hofheinz R" first="Ralf" last="Hofheinz">Ralf Hofheinz</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Day Treatment Center (TTZ), Interdisciplinary Tumor Center Mannheim (ITM) and 3rd Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>3 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Kienle, Peter" sort="Kienle, Peter" uniqKey="Kienle P" first="Peter" last="Kienle">Peter Kienle</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg</s1><s2>Mannheim</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Kieser, Meinhard" sort="Kieser, Meinhard" uniqKey="Kieser M" first="Meinhard" last="Kieser">Meinhard Kieser</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Institute of Medical Biometry and Informatics, University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Slanger, Tracy E" sort="Slanger, Tracy E" uniqKey="Slanger T" first="Tracy E." last="Slanger">Tracy E. Slanger</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Institute for Quality and Efficiency in Health Care (IQWiG)</s1><s2>Cologne</s2><s3>DEU</s3><sZ>6 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Institute for Quality and Efficiency in Health Care (IQWiG)</wicri:noRegion><wicri:noRegion>Institute for Quality and Efficiency in Health Care (IQWiG)</wicri:noRegion></affiliation></author><author><name sortKey="Burmeister, Bryan" sort="Burmeister, Bryan" uniqKey="Burmeister B" first="Bryan" last="Burmeister">Bryan Burmeister</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Queensland, Princess Alexandra Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Kelsen, David" sort="Kelsen, David" uniqKey="Kelsen D" first="David" last="Kelsen">David Kelsen</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College</s1><s2>New York, NY</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College</wicri:noRegion></affiliation></author><author><name sortKey="Niedzwiecki, Donna" sort="Niedzwiecki, Donna" uniqKey="Niedzwiecki D" first="Donna" last="Niedzwiecki">Donna Niedzwiecki</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Cancer and Leukemia Group B Statistical Center, Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Durham, NC</wicri:noRegion></affiliation></author><author><name sortKey="Schuhmacher, Christoph" sort="Schuhmacher, Christoph" uniqKey="Schuhmacher C" first="Christoph" last="Schuhmacher">Christoph Schuhmacher</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>Department of Surgery, Klinikum rechts der Isar, Technische Universität München</s1><s2>Munich</s2><s3>DEU</s3><sZ>10 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Urba, Susan" sort="Urba, Susan" uniqKey="Urba S" first="Susan" last="Urba">Susan Urba</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Division of Hematology/Oncology, University of Michigan Medical Center</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor, MI</wicri:noRegion></affiliation></author><author><name sortKey="Van De Velde, Cornelis" sort="Van De Velde, Cornelis" uniqKey="Van De Velde C" first="Cornelis" last="Van De Velde">Cornelis Van De Velde</name><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Department of Surgery, Leiden University Medical Center</s1><s2>Leiden</s2><s3>NLD</s3><sZ>12 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Walsh, Thomas N" sort="Walsh, Thomas N" uniqKey="Walsh T" first="Thomas N." last="Walsh">Thomas N. Walsh</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Department of Surgery, Connolly Hospital Blanchardstown</s1><s2>Dublin</s2><s3>IRL</s3><sZ>13 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Ychou, Marc" sort="Ychou, Marc" uniqKey="Ychou M" first="Marc" last="Ychou">Marc Ychou</name><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Centre Regional de Lutte Contre le Cancer</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Jensen, Katrin" sort="Jensen, Katrin" uniqKey="Jensen K" first="Katrin" last="Jensen">Katrin Jensen</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Institute of Medical Biometry and Informatics, University of Heidelberg</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">European journal of cancer : (1990)</title><title level="j" type="abbreviated">Eur. j. cancer : (1990)</title><idno type="ISSN">0959-8049</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">European journal of cancer : (1990)</title><title level="j" type="abbreviated">Eur. j. cancer : (1990)</title><idno type="ISSN">0959-8049</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adenocarcinoma</term><term>Aggregate</term><term>Cancerology</term><term>Chemoradiotherapy</term><term>Chemotherapy</term><term>Comparative study</term><term>Data analysis</term><term>Esophagus cancer</term><term>Evidence-based medicine</term><term>Human</term><term>Metaanalysis</term><term>Preoperative</term><term>Primary</term><term>Stomach cancer</term><term>Surgery</term><term>Systematic review</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Chirurgie</term><term>Préopératoire</term><term>Traitement</term><term>Adénocarcinome</term><term>Etude comparative</term><term>Primaire</term><term>Cancer de l'oesophage</term><term>Revue systématique</term><term>Médecine factuelle</term><term>Cancer de l'estomac</term><term>Métaanalyse</term><term>Homme</term><term>Chimiothérapie</term><term>Agrégat</term><term>Chimioradiothérapie</term><term>Analyse donnée</term><term>Cancérologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The prognosis of patients with gastroesophageal adenocarcinoma is poor. There is conflicting evidence regarding effects of preoperative chemotherapy on survival and other outcomes. Methods: We conducted a meta-analysis with aggregate and individual patient data (IPD) to assess the effect of preoperative chemotherapy for gastroesophageal adenocarcinoma on survival and other outcomes. Two independent reviewers identified eligible randomised controlled trials (RCTs) comparing chemotherapy+/-radiotherapy followed by surgery with surgery alone for gastroesophageal adenocarcinoma. IPD was solicited from all trials. Meta-analyses were performed using the two stage method. Results: We identified 14 RCTs (2422 patients). For eight RCTs (1049 patients; 43.3%) we obtained IPD. Preoperative chemotherapy was associated with longer overall survival (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.73-0.89; p < 0.0001). There were larger treatment effects in tumours of the gastroesophageal junction and for chemoradiotherapy compared to chemotherapy, but the tests for subgroup differences were not statistically significant. Preoperative chemotherapy was associated with longer disease-free survival, higher likelihood of R0 resection and more favourable post-treatment tumour stage, but not perioperative complications. Conclusion: Preoperative chemotherapy for locoregional gastroesophageal adenocarcinoma increases survival compared to surgery alone. It should be offered to all eligible patients. There appear to be larger survival advantages in tumours of the gastroesophageal junction and for chemoradiotherapy, but these findings require prospective confirmation.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Asie/explor/AustralieFrV1/Data/Main/Curation
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 004D30 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Curation/biblio.hfd -nk 004D30 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Asie
|area= AustralieFrV1
|flux= Main
|étape= Curation
|type= RBID
|clé= Pascal:13-0329031
|texte= Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
}}
| This area was generated with Dilib version V0.6.33. |  |