Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis

• Published in: Cancers Vol. 11; no. 4; p. 530
• Main Authors: van den Ende, Tom, Ter Veer, Emil, Mali, Rosa M A, van Berge Henegouwen, Mark I, Hulshof, Maarten C C M, van Oijen, Martijn G H, van Laarhoven, Hanneke W M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 12.04.2019; MDPI
• Subjects: Bias; Cancer therapies; Chemotherapy; Clinical trials; Esophageal cancer; Esophagus; Gastric cancer; Gender; Lymphatic system; Medical prognosis; Meta-analysis; Metastasis; Multivariate analysis; Neutrophils; Patients; Radiation therapy; Statistical analysis; Systematic review; Tumors; stomach neoplasms; adjuvant; chemotherapy; neoadjuvant therapy; prognosis; esophageal neoplasms
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers11040530

An overview of promising prognostic variables and predictive subgroups concerning the curative treatment of esophageal and gastric cancer from randomized controlled trials (RCTs) is lacking. Therefore, we conducted a systematic review and meta-analysis. PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to March 2019 for RCTs on the curative treatment of esophageal or gastric cancer with data on prognostic and/or predictive factors for overall survival. Prognostic factors were deemed potentially clinically relevant according to the following criteria; (1) statistically significant ( < 0.05) in a multivariate analysis, (2) reported in at least 250 patients, and (3) < 0.05, in ≥ 33% of the total number of patients in RCTs reporting this factor. Predictive factors were potentially clinically-relevant if (1) the -value for interaction between subgroups was <0.20 and (2) the hazard ratio in one of the subgroups was significant ( < 0.05). For gastric cancer, 39 RCTs were identified ( = 13,530 patients) and, for esophageal cancer, 33 RCTs were identified ( = 8618 patients). In total, we identified 23 potentially clinically relevant prognostic factors for gastric cancer and 16 for esophageal cancer. There were 15 potentially clinically relevant predictive factors for gastric cancer and 10 for esophageal cancer. The identified prognostic and predictive factors can be included and analyzed in future RCTs and be of guidance for nomograms. Further validation should be performed in large patient cohorts.