Chinese Patients with Gastric Cancer Need Targeted Adjuvant Chemotherapy Schemes

Background: Gastric cancer (GC) is one of the most common cancers in China. Adjuvant chemotherapy(AC) is a routine auxiliary treatment for GC recommended by the guidelines issued in 2011 by the Ministry ofHealth of the People’s Republic of China, but the relevant credible consequences in China have been insufficientbecause of China’s late start and ethical concerns.
Methods: A series of databases, including Cochrane Library,MEDLINE, EMBASE, the Chinese database of the National Knowledge Infrastructure and the VIP database,were searched by 2 reviewers independently for studies investigating AC for GC through March 2012. Theretrieved literature was screened according to the eligibility criteria.
Results: A total of 35 randomized controltrials (RCTs) were subjected to the final analysis, including 4,043 patients in treatment group and 3,884 inthe control group, as well as 4 clinical-control trials (CCTs), which accessed the final analysis with 238 and252 patients, respectively. AC reduced the risk of death as a protective treatment with statistical significance(HR=0.91, 95%CI: [0.85, 0.97], P=0.002), and it seemed more effective for Asian than non-Asian patients. Theeffects of AC were not influenced by the starting time (P>0.05). D2 lymphadenectomy-based chemotherapywas effective (HR=0.89, 95%CI: [0.80, 0.99], P=0.04). Oral S-1 40 mg/m2 after D2 lymphadenectomy mightbe a better choice for Asians with advanced GC and might result in a greater reduction of adverse events thanin non-Asian patients. GRADE quality assessment determined that the strength of the evidence from foreignstudies from Europe, the United States and Asian countries other than China was high, while it was moderatefor Chinese studies.
Conclusion: AC was effective or even curative in Chinese patients in general, although it isstill necessary to optimize a targeted AC scheme for Chinese patients with GC.