Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
Identifieur interne : 000776 ( PascalFrancis/Corpus ); précédent : 000775; suivant : 000777Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data
Auteurs : Ulrich Ronellenfitsch ; Matthias Schwarzbach ; Ralf Hofheinz ; Peter Kienle ; Meinhard Kieser ; Tracy E. Slanger ; Bryan Burmeister ; David Kelsen ; Donna Niedzwiecki ; Christoph Schuhmacher ; Susan Urba ; Cornelis Van De Velde ; Thomas N. Walsh ; Marc Ychou ; Katrin JensenSource :
- European journal of cancer : (1990) [ 0959-8049 ] ; 2013.
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- Pascal (Inist)
English descriptors
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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.
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| NO : | PASCAL 13-0329031 INIST |
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| ET : | Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data |
| AU : | RONELLENFITSCH (Ulrich); SCHWARZBACH (Matthias); HOFHEINZ (Ralf); KIENLE (Peter); KIESER (Meinhard); SLANGER (Tracy E.); BURMEISTER (Bryan); KELSEN (David); NIEDZWIECKI (Donna); SCHUHMACHER (Christoph); URBA (Susan); VAN DE VELDE (Cornelis); WALSH (Thomas N.); YCHOU (Marc); JENSEN (Katrin) |
| AF : | Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg/Mannheim/Allemagne (1 aut., 4 aut.); Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst/Frankfurt/Allemagne (2 aut.); 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/Mannheim/Allemagne (3 aut.); Institute of Medical Biometry and Informatics, University of Heidelberg/Heidelberg/Allemagne (5 aut., 15 aut.); Institute for Quality and Efficiency in Health Care (IQWiG)/Cologne/Allemagne (6 aut.); University of Queensland, Princess Alexandra Hospital/Brisbane/Australie (7 aut.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College/New York, NY/Etats-Unis (8 aut.); Cancer and Leukemia Group B Statistical Center, Duke University Medical Center/Durham, NC/Etats-Unis (9 aut.); Department of Surgery, Klinikum rechts der Isar, Technische Universität München/Munich/Allemagne (10 aut.); Division of Hematology/Oncology, University of Michigan Medical Center/Ann Arbor, MI/Etats-Unis (11 aut.); Department of Surgery, Leiden University Medical Center/Leiden/Pays-Bas (12 aut.); Department of Surgery, Connolly Hospital Blanchardstown/Dublin/Irlande (13 aut.); Centre Regional de Lutte Contre le Cancer/Montpellier/France (14 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | European journal of cancer : (1990); ISSN 0959-8049; Royaume-Uni; Da. 2013; Vol. 49; No. 15; Pp. 3149-3158; Bibl. 46 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B02; 002B04C |
| FD : | Chirurgie; Préopératoire; Traitement; Adénocarcinome; Etude comparative; Primaire; Cancer de l'oesophage; Revue systématique; Médecine factuelle; Cancer de l'estomac; Métaanalyse; Homme; Chimiothérapie; Agrégat; Chimioradiothérapie; Analyse donnée; Cancérologie |
| FG : | Pratique basée sur des preuves; Tumeur maligne; Cancer; Pathologie de l'appareil digestif; Pathologie de l'oesophage; Pathologie de l'estomac |
| ED : | Surgery; Preoperative; Treatment; Adenocarcinoma; Comparative study; Primary; Esophagus cancer; Systematic review; Evidence-based medicine; Stomach cancer; Metaanalysis; Human; Chemotherapy; Aggregate; Chemoradiotherapy; Data analysis; Cancerology |
| EG : | Evidence-based practice; Malignant tumor; Cancer; Digestive diseases; Esophageal disease; Gastric disease |
| SD : | Cirugía; Preoperatorio; Tratamiento; Adenocarcinoma; Estudio comparativo; Primario; Cáncer del esófago; Revisión sistemática; Medicina basada en pruebas; Cáncer del estómago; Meta-análisis; Hombre; Quimioterapia; Agregado; Quimioradioterapia; Análisis datos; Cancerología |
| LO : | INIST-12648.354000508223200110 |
| ID : | 13-0329031 |
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Walsh</name><affiliation><inist:fA14 i1="12"><s1>Department of Surgery, Connolly Hospital Blanchardstown</s1><s2>Dublin</s2><s3>IRL</s3><sZ>13 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Ychou, Marc" sort="Ychou, Marc" uniqKey="Ychou M" first="Marc" last="Ychou">Marc Ychou</name><affiliation><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></affiliation></author><author><name sortKey="Jensen, Katrin" sort="Jensen, Katrin" uniqKey="Jensen K" first="Katrin" last="Jensen">Katrin Jensen</name><affiliation><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></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></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><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></affiliation></author><author><name sortKey="Schwarzbach, Matthias" sort="Schwarzbach, Matthias" uniqKey="Schwarzbach M" first="Matthias" last="Schwarzbach">Matthias Schwarzbach</name><affiliation><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></affiliation></author><author><name sortKey="Hofheinz, Ralf" sort="Hofheinz, Ralf" uniqKey="Hofheinz R" first="Ralf" last="Hofheinz">Ralf Hofheinz</name><affiliation><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></affiliation></author><author><name sortKey="Kienle, Peter" sort="Kienle, Peter" uniqKey="Kienle P" first="Peter" last="Kienle">Peter Kienle</name><affiliation><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></affiliation></author><author><name sortKey="Kieser, Meinhard" sort="Kieser, Meinhard" uniqKey="Kieser M" first="Meinhard" last="Kieser">Meinhard Kieser</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Burmeister, Bryan" sort="Burmeister, Bryan" uniqKey="Burmeister B" first="Bryan" last="Burmeister">Bryan Burmeister</name><affiliation><inist:fA14 i1="06"><s1>University of Queensland, Princess Alexandra Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Kelsen, David" sort="Kelsen, David" uniqKey="Kelsen D" first="David" last="Kelsen">David Kelsen</name><affiliation><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></affiliation></author><author><name sortKey="Niedzwiecki, Donna" sort="Niedzwiecki, Donna" uniqKey="Niedzwiecki D" first="Donna" last="Niedzwiecki">Donna Niedzwiecki</name><affiliation><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></affiliation></author><author><name sortKey="Schuhmacher, Christoph" sort="Schuhmacher, Christoph" uniqKey="Schuhmacher C" first="Christoph" last="Schuhmacher">Christoph Schuhmacher</name><affiliation><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></affiliation></author><author><name sortKey="Urba, Susan" sort="Urba, Susan" uniqKey="Urba S" first="Susan" last="Urba">Susan Urba</name><affiliation><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></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><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></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><inist:fA14 i1="12"><s1>Department of Surgery, Connolly Hospital Blanchardstown</s1><s2>Dublin</s2><s3>IRL</s3><sZ>13 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Ychou, Marc" sort="Ychou, Marc" uniqKey="Ychou M" first="Marc" last="Ychou">Marc Ychou</name><affiliation><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></affiliation></author><author><name sortKey="Jensen, Katrin" sort="Jensen, Katrin" uniqKey="Jensen K" first="Katrin" last="Jensen">Katrin Jensen</name><affiliation><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></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></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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0959-8049</s0></fA01><fA03 i2="1"><s0>Eur. j. cancer : (1990)</s0></fA03><fA05><s2>49</s2></fA05><fA06><s2>15</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data</s1></fA08><fA11 i1="01" i2="1"><s1>RONELLENFITSCH (Ulrich)</s1></fA11><fA11 i1="02" i2="1"><s1>SCHWARZBACH (Matthias)</s1></fA11><fA11 i1="03" i2="1"><s1>HOFHEINZ (Ralf)</s1></fA11><fA11 i1="04" i2="1"><s1>KIENLE (Peter)</s1></fA11><fA11 i1="05" i2="1"><s1>KIESER (Meinhard)</s1></fA11><fA11 i1="06" i2="1"><s1>SLANGER (Tracy E.)</s1></fA11><fA11 i1="07" i2="1"><s1>BURMEISTER (Bryan)</s1></fA11><fA11 i1="08" i2="1"><s1>KELSEN (David)</s1></fA11><fA11 i1="09" i2="1"><s1>NIEDZWIECKI (Donna)</s1></fA11><fA11 i1="10" i2="1"><s1>SCHUHMACHER (Christoph)</s1></fA11><fA11 i1="11" i2="1"><s1>URBA (Susan)</s1></fA11><fA11 i1="12" i2="1"><s1>VAN DE VELDE (Cornelis)</s1></fA11><fA11 i1="13" i2="1"><s1>WALSH (Thomas N.)</s1></fA11><fA11 i1="14" i2="1"><s1>YCHOU (Marc)</s1></fA11><fA11 i1="15" i2="1"><s1>JENSEN (Katrin)</s1></fA11><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></fA14><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></fA14><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></fA14><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></fA14><fA14 i1="05"><s1>Institute for Quality and Efficiency in Health Care (IQWiG)</s1><s2>Cologne</s2><s3>DEU</s3><sZ>6 aut.</sZ></fA14><fA14 i1="06"><s1>University of Queensland, Princess Alexandra Hospital</s1><s2>Brisbane</s2><s3>AUS</s3><sZ>7 aut.</sZ></fA14><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></fA14><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></fA14><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></fA14><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></fA14><fA14 i1="11"><s1>Department of Surgery, Leiden University Medical Center</s1><s2>Leiden</s2><s3>NLD</s3><sZ>12 aut.</sZ></fA14><fA14 i1="12"><s1>Department of Surgery, Connolly Hospital Blanchardstown</s1><s2>Dublin</s2><s3>IRL</s3><sZ>13 aut.</sZ></fA14><fA14 i1="13"><s1>Centre Regional de Lutte Contre le Cancer</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>14 aut.</sZ></fA14><fA20><s1>3149-3158</s1></fA20><fA21><s1>2013</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>12648</s2><s5>354000508223200110</s5></fA43><fA44><s0>0000</s0><s1>© 2013 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>46 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>13-0329031</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>European journal of cancer : (1990)</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B02</s0></fC02><fC02 i1="02" i2="X"><s0>002B04C</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Chirurgie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Surgery</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Cirugía</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Préopératoire</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Preoperative</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Preoperatorio</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Traitement</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Treatment</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Tratamiento</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Adénocarcinome</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Adenocarcinoma</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Adenocarcinoma</s0><s5>04</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Etude comparative</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Comparative study</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Estudio comparativo</s0><s5>05</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Primaire</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Primary</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Primario</s0><s5>06</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Cancer de l'oesophage</s0><s2>NM</s2><s5>07</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Esophagus cancer</s0><s2>NM</s2><s5>07</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Cáncer del esófago</s0><s2>NM</s2><s5>07</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Revue systématique</s0><s2>FM</s2><s5>08</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Systematic review</s0><s2>FM</s2><s5>08</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Revisión 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i1="13" i2="X" l="ENG"><s0>Chemotherapy</s0><s5>13</s5></fC03><fC03 i1="13" i2="X" l="SPA"><s0>Quimioterapia</s0><s5>13</s5></fC03><fC03 i1="14" i2="X" l="FRE"><s0>Agrégat</s0><s5>17</s5></fC03><fC03 i1="14" i2="X" l="ENG"><s0>Aggregate</s0><s5>17</s5></fC03><fC03 i1="14" i2="X" l="SPA"><s0>Agregado</s0><s5>17</s5></fC03><fC03 i1="15" i2="X" l="FRE"><s0>Chimioradiothérapie</s0><s5>18</s5></fC03><fC03 i1="15" i2="X" l="ENG"><s0>Chemoradiotherapy</s0><s5>18</s5></fC03><fC03 i1="15" i2="X" l="SPA"><s0>Quimioradioterapia</s0><s5>18</s5></fC03><fC03 i1="16" i2="X" l="FRE"><s0>Analyse donnée</s0><s5>19</s5></fC03><fC03 i1="16" i2="X" l="ENG"><s0>Data analysis</s0><s5>19</s5></fC03><fC03 i1="16" i2="X" l="SPA"><s0>Análisis datos</s0><s5>19</s5></fC03><fC03 i1="17" i2="X" l="FRE"><s0>Cancérologie</s0><s5>20</s5></fC03><fC03 i1="17" i2="X" l="ENG"><s0>Cancerology</s0><s5>20</s5></fC03><fC03 i1="17" i2="X" l="SPA"><s0>Cancerología</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pratique basée sur des preuves</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Evidence-based practice</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Práctica basada en la evidencia</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Tumeur maligne</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Malignant tumor</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Tumor maligno</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Cancer</s0><s2>NM</s2></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cancer</s0><s2>NM</s2></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Cáncer</s0><s2>NM</s2></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie de l'appareil digestif</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Digestive diseases</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Aparato digestivo patología</s0><s5>38</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Pathologie de l'oesophage</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Esophageal disease</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Esófago patología</s0><s5>39</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie de l'estomac</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Gastric disease</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Estómago patología</s0><s5>40</s5></fC07><fN21><s1>308</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 13-0329031 INIST</NO><ET>Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data</ET><AU>RONELLENFITSCH (Ulrich); SCHWARZBACH (Matthias); HOFHEINZ (Ralf); KIENLE (Peter); KIESER (Meinhard); SLANGER (Tracy E.); BURMEISTER (Bryan); KELSEN (David); NIEDZWIECKI (Donna); SCHUHMACHER (Christoph); URBA (Susan); VAN DE VELDE (Cornelis); WALSH (Thomas N.); YCHOU (Marc); JENSEN (Katrin)</AU><AF>Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg/Mannheim/Allemagne (1 aut., 4 aut.); Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst/Frankfurt/Allemagne (2 aut.); 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/Mannheim/Allemagne (3 aut.); Institute of Medical Biometry and Informatics, University of Heidelberg/Heidelberg/Allemagne (5 aut., 15 aut.); Institute for Quality and Efficiency in Health Care (IQWiG)/Cologne/Allemagne (6 aut.); University of Queensland, Princess Alexandra Hospital/Brisbane/Australie (7 aut.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College/New York, NY/Etats-Unis (8 aut.); Cancer and Leukemia Group B Statistical Center, Duke University Medical Center/Durham, NC/Etats-Unis (9 aut.); Department of Surgery, Klinikum rechts der Isar, Technische Universität München/Munich/Allemagne (10 aut.); Division of Hematology/Oncology, University of Michigan Medical Center/Ann Arbor, MI/Etats-Unis (11 aut.); Department of Surgery, Leiden University Medical Center/Leiden/Pays-Bas (12 aut.); Department of Surgery, Connolly Hospital Blanchardstown/Dublin/Irlande (13 aut.); Centre Regional de Lutte Contre le Cancer/Montpellier/France (14 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>European journal of cancer : (1990); ISSN 0959-8049; Royaume-Uni; Da. 2013; Vol. 49; No. 15; Pp. 3149-3158; Bibl. 46 ref.</SO><LA>Anglais</LA><EA>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.</EA><CC>002B02; 002B04C</CC><FD>Chirurgie; Préopératoire; Traitement; Adénocarcinome; Etude comparative; Primaire; Cancer de l'oesophage; Revue systématique; Médecine factuelle; Cancer de l'estomac; Métaanalyse; Homme; Chimiothérapie; Agrégat; Chimioradiothérapie; Analyse donnée; Cancérologie</FD><FG>Pratique basée sur des preuves; Tumeur maligne; Cancer; Pathologie de l'appareil digestif; Pathologie de l'oesophage; Pathologie de l'estomac</FG><ED>Surgery; Preoperative; Treatment; Adenocarcinoma; Comparative study; Primary; Esophagus cancer; Systematic review; Evidence-based medicine; Stomach cancer; Metaanalysis; Human; Chemotherapy; Aggregate; Chemoradiotherapy; Data analysis; Cancerology</ED><EG>Evidence-based practice; Malignant tumor; Cancer; Digestive diseases; Esophageal disease; Gastric disease</EG><SD>Cirugía; Preoperatorio; Tratamiento; Adenocarcinoma; Estudio comparativo; Primario; Cáncer del esófago; Revisión sistemática; Medicina basada en pruebas; Cáncer del estómago; Meta-análisis; Hombre; Quimioterapia; Agregado; Quimioradioterapia; Análisis datos; Cancerología</SD><LO>INIST-12648.354000508223200110</LO><ID>13-0329031</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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