Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Results
2.1. Risk of Bias
2.2. Prognostic Factors
2.3. Predictive Factors
3. Discussion
3.1. Prognostic Factors for Overall Survival in Gastric and Esophageal Cancer
3.2. Predictive Factors for Overall Survival in Gastric Cancer
3.3. Predictive Factors for Overall Survival in Esophageal Cancer
3.4. Strengths and Limitations
4. Materials and Methods
4.1. Literature Search
4.2. Study Selection and Quality Assessment
4.3. Data Extraction and Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Gastric Cancer | ||
---|---|---|
Prognostic Factor | Subgroup | Strategy |
Age (years) | <65 vs. ≥65, <60 vs. 60–69, <60 vs. 70–80, <74 vs. ≥74, Increasing age | Neo [103] Adj [4,5,22,26,31,45,87] |
AREG expression | High vs. Low | Adj [89] |
Center size (No. trial patients) | Large (≥20) vs. Small (≤5) | Adj [35] |
Comorbidity | None vs. 1–2 or ≥3 | Neo [103] |
Country of origin | South Korea vs. China/Taiwan | Adj [5] |
EGFR expression | Negative vs. Positive | Adj [90] |
Hemoglobin | NR | Adj [27] |
Hospital resection volume (per year) | ≥20 vs. 1–20 | Neo [103] |
IGFR1R expression | Low vs. High | Adj [89] |
Lymph node ratio invaded/removed | ≤0.3 vs. >0.3, 0–25% vs. >25% | Adj [35,108] |
M stage | M0 vs. M1 | Neo, Adj [20,33] |
Maruyama index | <5 vs. ≥5 | Adj [86] |
Microsatellite instability | MSI vs. MSS | Neo and Adj [18] |
N stage | N− vs. N+, N0 vs. N1 or N1–2, pN0 vs. pN1–3, N0–N1 vs. N2–N3, N1 vs. N2, N ≤ 6 vs. N > 6, N 0–7 vs. N 8–15, N 0–7 vs. N > 15 | Neo [28,33,103], Adj [5,19,20,21,22,24,25,26,27,42,43,84,87] |
Number of nodes examined | >15 vs. ≤15 | Adj [26] |
Osteopontin expression | 0/1+ vs. 3+ | Adj [85] |
Pathological R stage | R0 vs. R1, R0 vs. R1, R2 | Neo [23,28,103], Adj [20,84] |
Relative dose intensity (MMC+5-FU+UFT) | >0.98 vs. <0.98 | Adj [87] |
Race | Asian vs. Caucasian (benefit in subgroup NR) | Neo and Adj [18] |
Stage | II vs. IIIA, II vs. IIIB, IB/IIA vs. IIB/IIIA, IB/IIA vs. IIIB, IB/IIA vs. IIIC, IB/II vs. III/IV | Adj [4,5,20,24,34,37,40,42,45,53] |
T stage | pT0/pTis/pT1 vs. pT3-4, pT1 vs. pT2, pT1 vs. pT3-T4, pT1-2 vs. pT3-4, pT3 vs. pT4, Mucosa versus Serosa | Neo [33,103], Adj [5,19,21,22,24,25,26,27,32,35,84,87] |
Weight | ≥57 kg vs. <57 kg | Adj [5] |
Weight loss (% of normal weight) | Before surgery | Adj [20] |
Esophageal cancer | |||
---|---|---|---|
Prognostic factor | Histology | Subgroup | Strategy |
Age (years) | AC and SCC | <60 vs. ≥60, or >70 | Neo [65,70] |
AC and SCC | 60–69 vs. <60 | dCRT [60] | |
SCC | <70 vs. ≥70 | Neo [62] | |
Albumin level | SCC | ≥4 vs. <4, pretreatment level | Neo, Adj, dCRT [71,107] |
Cisplatin intensity | AC and SCC | ≥75% vs. <75% | dCRT [98] |
Derived neutrophil to lymphocyte ratio | AC and SCC | <2 vs. ≥2 | dCRT [98] |
Dose of pre-operative chemotherapy | SCC | ≥90% vs. <90% | Neo [107] |
EGFR expression | SCC | Low vs. High | Adj [96] |
Full radiation dose | AC and SCC | Yes vs. No | dCRT [98] |
Histological grade | AC and SCC | Well/moderate vs. Poor | Neo [61,65] |
SCC | Well vs. Poor, Well vs. Moderate, Well/moderate vs. Poor | Neo [66,107] Adj [77] | |
Lymph node involvement | AC and SCC | No vs. Yes | Neo [61] |
AC and SCC | 0 vs. ≥1 | Neo [58] | |
SCC | No vs. Yes, Recurrence 1 node vs. >1 node | Neo, dCRT [66,75] | |
N stage | AC and SCC | cN0 vs. cN1, pN− vs. pN+ | Neo [64], dCRT [60] |
SCC | cN0 vs. cN1 | Neo [74] | |
Nutritional Risk Index baseline | AC and SCC | ≥100 vs. <100 | dCRT [100] |
Nutritional intervention baseline NRI <100 | AC and SCC | Dietary advice vs. None, Oral supplements vs. None, Major intervention vs. None | dCRT [100] |
R0 resection | AC and SCC | R0 vs. R1/R2/R3 | Neo [76] |
SCC | R0 vs. R1/R2 | Neo [74] | |
Stage | AC and SCC | I/II vs. III, I/II vs. III+IV | dCRT [98,101] |
SCC | I/II vs. III, I/II vs. III+IV, IIA vs. IIB | dCRT [71,75], Adj [77] | |
T stage | AC and SCC | cT1/T2 vs. cT3 or cT3–4 | Neo [83], dCRT [82] |
SCC | cT1/T2 vs. cT3 or cT4, pT1–2 vs. pT3 | Neo [10,66,80] dCRT [72] | |
Tumor size (cm) | AC and SCC | <5 vs. ≥5 | Neo [70] dCRT [82] |
SCC | <3 vs. ≥3, <5 vs. ≥5, <6 vs. ≥6 | Neo [62], dRT [63] Adj [77] |
Gastric Cancer | ||||||
---|---|---|---|---|---|---|
Factor | Study | Experimental | vs. | Comparator | HR (95%CI) | N |
Age (years) | ||||||
≥ 70 (vs. <70) | Cunningham 2017 [44] | Peri+Epi+Cis+Cap+BEV | < | Peri+Epi+Cis+Cap | 1.67 (1.10–2.52) | 1063 |
Gender | ||||||
Male (vs. female) | Noh 2014 [5] | Ox+Cap | > | Surg | 0.60 (0.45–0.81) | 1035 |
Female (vs. male) | Bajetta 2014 [45] | Dtx+IRI+Cis+5-FU/Lv | > | 5-FU/Lv | 0.73 (0.54–0.98) | 1100 |
Male (vs. female) | Smalley 2012 [6] | 5-FU/Lv+RT | > | Surg | 0.69 (0.55–0.86) | 559 |
T stage | ||||||
T1, T2 (vs. T3, T4) | Noh 2014 [5] | Ox+Cap | > | Surg | 0.49 (0.33–0.74) | 1035 |
Nodal stage | ||||||
N0 (vs. N1, N2) | Sasako 2011 [4] | S-1 | > | Surg | 0.32 (0.13–0.79) | 1034 |
N1 (vs. N0, N2) | Sasako 2011 [4] | S-1 | > | Surg | 0.61 (0.44–0.84) | 1034 |
Histopathological grade | ||||||
G1, G2 (vs. G3, G4, GX) | Noh 2014 [5] | Ox+Cap | > | Surg | 0.50 (0.31–0.82) | 1035 |
No. of examined lymph nodes | ||||||
15–24 (vs. <15 and ≥25) | Bajetta 2014 [45] | Dtx+IRI+Cis+5-FU/Lv | < | 5-FU/Lv | 1.48 (1.09–2.01) | 1100 |
Race | ||||||
African American (vs. other) | Smalley 2012 [6] | 5-FU/Lv+RT | > | Surg | 0.56 (0.33–0.95) | 559 |
Histology | ||||||
Intestinal (vs. diffuse) | Smalley 2012 [6] | 5-FU/Lv+RT | > | Surg | 0.71 (0.54–0.94) | 559 |
Gender and histology | ||||||
Men intestinal (vs. women intestinal, women diffuse, men diffuse) | Smalley 2012 [6] | 5-FU/Lv+RT | > | Surg | 0.72 (0.52–0.98) | 559 |
Woman diffuse (vs. women intestinal, men intestinal, men diffuse) | Smalley 2012 [6] | 5-FU/Lv+RT | < | Surg | 2.22 (1.14–4.35) | 559 |
No. nodal metastasis | ||||||
0 vs. (>1) | Sasako 2011 [6] | S-1 | > | Surg | 0.32 (0.13–0.79) | 1034 |
1–2 vs. (0 and ≥3) | Sasako 2011 [6] | S-1 | > | Surg | 0.45 (0.28–0.75) | 1034 |
Stage | ||||||
Stage III (vs. stage II) | Jeung 2008 [36] | Doxo+5-FU+PAU | > | Doxo+5-FU | 0.70 (0.51–0.97) | 292 |
TS expression | ||||||
High (vs. low) | Sasako 2011 [92] | S-1 | > | Surg | 0.37 (0.22–0.62) | 808 |
DPD expression | ||||||
High (vs. low) | Sasako 2011 [92] | S-1 | > | Surg | 0.52 (0.38–0.72) | 807 |
HER2 expression FISH | ||||||
Non-amplified (vs. amplified) | Smalley 2012 [94] | 5-FU/Lv+RT | > | Surg | 0.63 (0.47–0.85) | 258 |
Microsatellite instability | ||||||
MSS (vs. MSI) | Pietrantonio 2019 [18] (IPD of MAGIC, ARTIST, ITACA-S and CLASSIC) | Perioperative or adjuvant chemotherapy | > | Surg | 0.73 (0.61–0.86) | 1552 |
MSS (vs. MSI) | Pietrantonio 2019 [18] (IPD of MAGIC and CLASSIC) | Perioperative or adjuvant chemotherapy | > | Surg | 0.71 (0.58–0.88) | 1552 |
Esophageal Cancer | ||||||
---|---|---|---|---|---|---|
Factor | Study | Experimental | vs. | Comparator | HR (95%CI) | N (histology) |
Age (years) | ||||||
>60 (vs. <60) | Boonstra 2011 [54] | Neo+Eto+Cis | > | Surg | 0.63 (0.39–1.00) | 169 (SCC) |
>70 (vs. <69) | MRC 2002 [11] | Neo+Cis+5-FU | > | Surg | 0.64 (0.44–0.91) | 802 (AC, SCC) |
<60 (vs. >60) | MRC 2002 [11] | Neo+Cis+5-FU | > | Surg | 0.71 (0.55–0.94) | 802 (AC, SCC) |
60–69 (<60 and ≥70) | Alderson 2017 [44] | Neo+Epi+Cis+Cap | > | Neo+Cis+5-FU | 0.72 (0.57–0.91) | 629 (AC) |
Gender | ||||||
Male (vs. female) | Crosby 2017 [98] | dCRT-Cis+Cap+CTX+RT | < | dCRT-Cis+Cap+RT | 1.87 (1.26–2.77) | 432 (AC, SCC) |
Female (vs. male) | Stahl 2017 [56] | Neo+Eto+Cis+5-FU/Lv+RT | > | Neo+Cis+5-FU/Lv | 0.18 (0.03–0.95) | 119 (AC) |
Female (vs. male) | Liu 2018 [80] | Neo+Vin+Cis+RT | > | Surg | 0.34 (0.15–0.80) | 451 (SCC) |
Histology | ||||||
SCC (vs. AC) | Shapiro 2015 [8] | Neo+Ptx+Car+RT | > | Surg | 0.46 (0.26–0.79) | 235 (AC, SCC) |
Stage | ||||||
II (vs. III) | Ando 2012 [10] | Neo+Cis+5-FU | > | Cis+5-FU | 0.60 (0.36–0.96) | 329 (SCC) |
cT stage | ||||||
cT1-2 (vs. cT3) | Ando 2012 [10] | Neo+Cis+5-FU | > | Cis+5-FU | 0.36 (0.17–0.80) | 330 (SCC) |
cT3 (vs. cT1-2 and cT4) | Liu 2018 [80] | Neo+Vin+Cis+RT | > | Surg | 0.56 (0.38–0.82) | 451 (SCC) |
N stage | ||||||
cN0 (vs. cN1) | Shapiro 2015 [8] | Neo+Ptx+Car+RT | > | Surg | 0.49 (0.30–0.80) | 231 (AC, SCC) |
N0 (vs. N1) | Alderson 2017 [55] | Neo+Epi+Cis+Cap | > | Neo+Cis+5-FU | 0.63 (0.45–0.90) | 624 (AC) |
Pretreatment weight loss | ||||||
>10% (vs. 6–10% and <5%) | Boonstra 2011 [54] | Neo+Eto+Cis | > | Surg | 0.40 (0.22–0.72) | 147 (SCC) |
Tumor location | ||||||
Middle (vs. upper-distal third) | Boonstra 2011 [54] | Neo+Eto+Cis | > | Surg | 0.47 (0.29–0.77) | 154 (SCC) |
Lower third (vs. upper/middle and cardia) | MRC 2002 [11] | Neo+Cis+5-FU | > | Surg | 0.74 (0.61–0.90) | 802 (AC, SCC) |
Dysphagia score | ||||||
1 (vs. 0 and >2) | MRC 2002 [11] | Neo+Cis+5-FU | > | Surg | 0.66 (0.61–0.85) | 754 (AC, SCC) |
Reasons for no surgery | ||||||
Comorbidity/poor PS (vs. patient choice and local extensive disease) | Crosby 2017 [98] | dCRT-Cis+Cap+CTX+RT | < | dCRT-Cis+Cap+RT | 3.00 (1.20–7.50) | 432 (AC, SCC) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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van den Ende, T.; ter Veer, E.; Mali, R.M.A.; van Berge Henegouwen, M.I.; Hulshof, M.C.C.M.; van Oijen, M.G.H.; van Laarhoven, H.W.M. Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis. Cancers 2019, 11, 530. https://doi.org/10.3390/cancers11040530
van den Ende T, ter Veer E, Mali RMA, van Berge Henegouwen MI, Hulshof MCCM, van Oijen MGH, van Laarhoven HWM. Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis. Cancers. 2019; 11(4):530. https://doi.org/10.3390/cancers11040530
Chicago/Turabian Stylevan den Ende, Tom, Emil ter Veer, Rosa M. A. Mali, Mark I. van Berge Henegouwen, Maarten C. C. M. Hulshof, Martijn G. H. van Oijen, and Hanneke W. M. van Laarhoven. 2019. "Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis" Cancers 11, no. 4: 530. https://doi.org/10.3390/cancers11040530