BACKGROUND Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer(>T2,N+)before tumour resection in many European guidelines.However,there is no consensus as to wh...BACKGROUND Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer(>T2,N+)before tumour resection in many European guidelines.However,there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours,in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.AIM To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy,localisation,and age.METHODS We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016.The data were evaluated particularly in relation to patient age,tumour site,and perioperative therapy.RESULTS Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population.The 5-year survival rates were 40%for patients who received perioperative chemotherapy and 29%for the group without perioperative chemotherapy(P=0.125).Our patients were on average distinctly older than patients in most of the published randomised controlled trials.Patients elder than 75 years received perioperative chemotherapy far less frequently.Patients with a proximal tumour received perioperative chemotherapy much more often.CONCLUSION This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer.There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.展开更多
BACKGROUND In 2015,Kidane published a Cochrane review and meta-analysis to summarise the impact of preoperative chemotherapy versus surgery alone on survival for resectable thoracic esophageal cancer.The authors concl...BACKGROUND In 2015,Kidane published a Cochrane review and meta-analysis to summarise the impact of preoperative chemotherapy versus surgery alone on survival for resectable thoracic esophageal cancer.The authors concluded that preoperative chemotherapy improved overall survival(OS).AIM The aim of this article was to assess the validity of the three most powerful studies included in the Cochrane review and the meta-analysis supporting the advantage of preoperative chemotherapy and to investigate the impact of an exclusion of these three studies on the result of the meta-analysis.METHODS OS was selected as the endpoint of interest.Among the ten included papers which analysed this endpoint,we identified the three publications with the highest weights influencing the final result.The validity of these papers was analysed using the CONSORT checklist for randomized controlled trials.We performed a new meta-analysis without the three studies to assess their impact on the general result of the original meta-analysis.RESULTS The three analysed studies revealed several inconsistencies.Inappropriate answers were found in up to one third of the items of the CONSORT checklist.Missing information about sample-size calculation and power,unclear or inadequate randomisation,and missing blinded set-up were the most common findings.When the three criticized studies were excluded in the meta-analysis,preoperative chemotherapy showed no benefit in OS.CONCLUSION The three most powerful publications in the Cochrane review show substantial deficits.After the exclusion of these studies from the meta-analysis,preoperative chemotherapy does not seem to result in an advantage in survival.We suggest a more critical appraisal regarding the validity of single studies.展开更多
BACKGROUND According to the result of the Cochrane review published in 2012,postoperative adjuvant chemotherapy(CTx)is associated with a survival benefit for rectal cancer patients operated for cure in comparison to p...BACKGROUND According to the result of the Cochrane review published in 2012,postoperative adjuvant chemotherapy(CTx)is associated with a survival benefit for rectal cancer patients operated for cure in comparison to patients who underwent only the surgical resection.AIM To analyze the quality of the data supporting the advantage of adjuvant CTx after surgery for rectal cancer.In the times of increasing health care costs,it is imperative to offer the patient an evidence-based therapy that justifies potential side effects as well as costs.METHODS Overall survival was selected as endpoint of interest.Among the 21 included papers which analyzed this endpoint,we identified those three publications which have the highest weights to influence the final result.The validity of these papers was analyzed using the CONSORT checklist for randomized controlled trials.We performed a second meta-analysis excluding the three analyzed studies(n=18)in order to assess their impact on the overall result of the original metaanalysis.Finally,we performed a third meta-analysis excluding all studies(n=16)which showed a statistically improved overall survival.RESULTS The detailed analysis of the three most relevant RCTs according to the items of the CONSORT checklist showed several pitfalls.In up to 47%of the items,inappropriate answers were found.Generally,a lack of information regarding therandomization procedure as well as the absence of allocation concealment,blinded set-up,of intention-to-treat analysis and omission of sample size calculation were common problems of the analyzed studies.The exclusion of these three studies from the meta-analysis did not affect the general result of the meta-analysis,still confirming a survival advantage after adjuvant chemotherapy.After exclusion of single studies with a statistically significant outcome improvement,the meta-analysis of the remaining 16 studies again shows a statistically significant result due in part to a large remaining sample size.CONCLUSION The three most powerful publications show substantial deficits.We suggest a more critical appraisal regarding the validity of single studies because a metaanalysis cannot overcome the limitations of individual trials by pooling treatment effect estimates to generate a single best estimate.展开更多
文摘BACKGROUND Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer(>T2,N+)before tumour resection in many European guidelines.However,there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours,in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.AIM To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy,localisation,and age.METHODS We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016.The data were evaluated particularly in relation to patient age,tumour site,and perioperative therapy.RESULTS Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population.The 5-year survival rates were 40%for patients who received perioperative chemotherapy and 29%for the group without perioperative chemotherapy(P=0.125).Our patients were on average distinctly older than patients in most of the published randomised controlled trials.Patients elder than 75 years received perioperative chemotherapy far less frequently.Patients with a proximal tumour received perioperative chemotherapy much more often.CONCLUSION This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer.There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.
文摘BACKGROUND In 2015,Kidane published a Cochrane review and meta-analysis to summarise the impact of preoperative chemotherapy versus surgery alone on survival for resectable thoracic esophageal cancer.The authors concluded that preoperative chemotherapy improved overall survival(OS).AIM The aim of this article was to assess the validity of the three most powerful studies included in the Cochrane review and the meta-analysis supporting the advantage of preoperative chemotherapy and to investigate the impact of an exclusion of these three studies on the result of the meta-analysis.METHODS OS was selected as the endpoint of interest.Among the ten included papers which analysed this endpoint,we identified the three publications with the highest weights influencing the final result.The validity of these papers was analysed using the CONSORT checklist for randomized controlled trials.We performed a new meta-analysis without the three studies to assess their impact on the general result of the original meta-analysis.RESULTS The three analysed studies revealed several inconsistencies.Inappropriate answers were found in up to one third of the items of the CONSORT checklist.Missing information about sample-size calculation and power,unclear or inadequate randomisation,and missing blinded set-up were the most common findings.When the three criticized studies were excluded in the meta-analysis,preoperative chemotherapy showed no benefit in OS.CONCLUSION The three most powerful publications in the Cochrane review show substantial deficits.After the exclusion of these studies from the meta-analysis,preoperative chemotherapy does not seem to result in an advantage in survival.We suggest a more critical appraisal regarding the validity of single studies.
文摘BACKGROUND According to the result of the Cochrane review published in 2012,postoperative adjuvant chemotherapy(CTx)is associated with a survival benefit for rectal cancer patients operated for cure in comparison to patients who underwent only the surgical resection.AIM To analyze the quality of the data supporting the advantage of adjuvant CTx after surgery for rectal cancer.In the times of increasing health care costs,it is imperative to offer the patient an evidence-based therapy that justifies potential side effects as well as costs.METHODS Overall survival was selected as endpoint of interest.Among the 21 included papers which analyzed this endpoint,we identified those three publications which have the highest weights to influence the final result.The validity of these papers was analyzed using the CONSORT checklist for randomized controlled trials.We performed a second meta-analysis excluding the three analyzed studies(n=18)in order to assess their impact on the overall result of the original metaanalysis.Finally,we performed a third meta-analysis excluding all studies(n=16)which showed a statistically improved overall survival.RESULTS The detailed analysis of the three most relevant RCTs according to the items of the CONSORT checklist showed several pitfalls.In up to 47%of the items,inappropriate answers were found.Generally,a lack of information regarding therandomization procedure as well as the absence of allocation concealment,blinded set-up,of intention-to-treat analysis and omission of sample size calculation were common problems of the analyzed studies.The exclusion of these three studies from the meta-analysis did not affect the general result of the meta-analysis,still confirming a survival advantage after adjuvant chemotherapy.After exclusion of single studies with a statistically significant outcome improvement,the meta-analysis of the remaining 16 studies again shows a statistically significant result due in part to a large remaining sample size.CONCLUSION The three most powerful publications show substantial deficits.We suggest a more critical appraisal regarding the validity of single studies because a metaanalysis cannot overcome the limitations of individual trials by pooling treatment effect estimates to generate a single best estimate.
