Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer.

BACKGROUND There is no consensus of opinion about postoperative adjuvant chemotherapy after radical surgery for advanced gastric cancer. This is a meta-analysis of the published results of relevant randomized clinical trials (RCTs). METHODS Electronic databases from January 1998 to December 2007 were searched and 12 RCTs were selected. These included a total of 3809 patients. The hazard ratio (HR) for overall survival was calculated. RESULTS The pooled HR for overall survival was 0.78 (95 per cent confidence interval 0.71 to 0.85) in favour of chemotherapy. Subgroup analysis showed that the advantage of chemotherapy was not influenced by depth of tumour infiltration, status of lymph node metastasis, type of lymphadenectomy, geographical distribution of patients or route of drug administration. CONCLUSIONS Postoperative chemotherapy can improve overall survival after radical surgery for gastric cancer; there is no standardized chemotherapy regimen. Japanese-style D2 radical surgery plus oral 5-fluorouracil appears an effective treatment at present.