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      Evaluation of neoadjuvant immunotherapy plus chemotherapy in Chinese surgically resectable gastric cancer: a pilot study by meta-analysis

      systematic-review

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          Abstract

          Background

          Recently, the use of immunochemotherapy in the treatment of advanced gastric cancer (GC) has been increasing and programmed cell death protein 1 (PD-1) inhibitors combined with chemotherapy has become the first-line treatment for advanced GC. However, few studies with small sample sizes have examined this treatment regimen to assess its effectiveness and safety in the neoadjuvant treatment phase of resectable local advanced GC.

          Materials and methods

          Herein, we systematically searched PubMed, Cochrane CENTRAL, and Web of Science for clinical trials on neoadjuvant immunochemotherapy (nICT) in advanced GC. The primary outcomes were effectiveness [evaluated by major pathological response (MPR) and pathological complete response (pCR)] and safety [assessed by grade 3–4 treatment-related adverse events (TRAEs) and postoperative complications]. A meta-analysis of non-comparative binary results was performed to aggregate the primary outcomes. Direct comparative analysis was used to compare pooled results of neoadjuvant chemotherapy (nCT) with nICT. The outcomes emerged as risk ratios (RR).

          Results

          Five articles with 206 patients were included, and all of them were from the Chinese population. The pooled pCR and MPR rates were 26.5% (95% CI: 21.3%–33.3%) and 49.0% (95% CI: 42.3%–55.9%), while grade 3–4 TRAEs and post-operative complication rates were 20.0% (95% CI: 9.1%–39.8%) and 30.1% (95% CI: 23.1%–37.9%), respectively. Direct comparison showed that with the exception of grade 3–4 TRAEs and postoperative complications, all outcomes including pCR, MPR, and R0 resection rate favoured nICT to nCT.

          Conclusion

          nICT is a promising strategy for use as an advisable neoadjuvant treatment for patients with advanced GC in Chinese population. However, more phase III randomized controlled trials (RCTs) will be required to further consolidate the efficacy and safety of this regimen.

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          Most cited references43

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          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

            The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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              Meta-analysis in clinical trials

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                Author and article information

                Contributors
                Journal
                Front Immunol
                Front Immunol
                Front. Immunol.
                Frontiers in Immunology
                Frontiers Media S.A.
                1664-3224
                23 June 2023
                2023
                : 14
                : 1193614
                Affiliations
                [1] 1 Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University , Nanjing, China
                [2] 2 Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medical University , Nanjing, China
                [3] 3 Department of General Surgery, Jiangyin People’s Hospital Affiliated to Nantong University , Wuxi, China
                Author notes

                Edited by: Huashan Shi, Sichuan University, China

                Reviewed by: Dongbo Jiang, Air Force Medical University, China; Zheng Chen, University of Miami, United States; Jin Zhou, The First Affiliated Hospital of Soochow University, China; Ye Zhou, Fudan University, China; Haoran Qian, Zhejiang University, China

                *Correspondence: Zekuan Xu, xuzekuan@ 123456njmu.edu.cn

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fimmu.2023.1193614
                10326549
                37426646
                74e0744a-0789-4fa9-995f-e6df18aca886
                Copyright © 2023 Xu, Li, Shao, Wang, He, Xu, Qian, Liu, Ge, Wang, Zhang, Yang, Li and Xu

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 March 2023
                : 12 June 2023
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 43, Pages: 7, Words: 2938
                Funding
                This work was supported grants from National Natural Science Foundation of China (grant number: 82072708); Youth Program of National Natural Science Foundation of China (grant number: 81902461).
                Categories
                Immunology
                Systematic Review
                Custom metadata
                Cancer Immunity and Immunotherapy

                Immunology
                resectable advanced gastric cancer,neoadjuvant immunochemotherapy,perioperative immunotherapy,neoadjuant chemotherapy,meta – analysis

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