Is neoadjuvant chemotherapy followed by surgery the appropriate treatment for esophagogastric signet ring cell carcinomas? A systematic review and meta-analysis.

Background

The impact of neoadjuvant chemotherapy (nCTX) on survival and tumor response in patients with esophagogastric signet ring cell carcinoma (SRCC) is still controversial.

Methods

Two independent reviewers performed a systematic literature search in Medline, CENTRAL, and Web of Science including prospective and retrospective two-arm non-randomized and randomized controlled studies (RCTs). Data was extracted on overall survival (OS) and tumor regression in resected esophagogastric SRCC patients with or without nCTX. Survival data was analyzed using published hazard ratios (HR) if available or determined it from other survival data or survival curves. OS and histopathological response rates by type of tumor (SRCC vs. non-SRCC) were also investigated.

Results

Out of 559 studies, ten (1 RCT, 9 non-RCTs) were included in this meta-analysis (PROSPERO CRD42022298743) investigating 3,653 patients in total. The four studies investigating survival in SRCC patients treated with nCTX + surgery vs. surgery alone showed no survival benefit for neither intervention, but heterogeneity was considerable (HR, 1.01; 95% CI, 0.61-1.67;

Conclusion

The current meta-analysis could not demonstrate beneficial effects of nCTX for SRCC patients. Histopathological response to and survival benefits of non-taxane-based nCTX seem to be lower in comparison to non-SRC esophagogastric cancer. However, certainty of evidence is low due to the scarcity of high-quality trials. Further research is necessary to determine optimal treatment for SRCC patients.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42022298743).

Informations de copyright

© 2024 Schiefer, Crnovrsanin, Kalkum, Vey, Nienhüser, Rompen, Haag, Müller-Stich, Billmann, Schmidt, Probst, Klotz and Sisic.

Déclaration de conflit d'intérêts

GH reports a consulting or advisory role for Bristol-Myers Squibb; MSD Sharp & Dohme; Lilly; Novartis; Daiichi Sankyo, Servier; Pierre Fabre. He received honoraria from Servier; MSD Sharp & Dohme; Lilly; Targos; Bristol-Myers Squibb; IOMEDICO, MCI Conventions. Research Funding was provided by Nordic Pharma; Taiho Pharmaceutical; MSD Sharp & Dohme. Travel; Accommodations were supported by Bristol-Myers Squibb; Lilly; Servier; MSD Sharp & Dohme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.