Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews
Por:
Santero, M, Perez-Bracchiglione, J, Acosta-Dighero, R, Meade, AG, Antequera, A, Auladell-Rispau, A, Quintana, MJ, Requeijo, C, Rodriguez-Grijalva, G, Salas-Gama, K, Dorantes-Romandia, R, Salazar, J, Sola, I, Urrutia, G, Cosp, XB
Publicada:
16 jun 2021
Resumen:
Background: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context.
Methods: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach.
Results: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence.
Conclusions: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed.
Filiaciones:
Santero, M:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Perez-Bracchiglione, J:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Univ Valparaiso, Interdisciplinary Ctr Hlth Studies CIESAL, Vina Del Mar, Chile
Acosta-Dighero, R:
Univ San Sebastian, Sch Physiotherapy, Fac Hlth Sci, Santiago, Chile
Meade, AG:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Antequera, A:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Auladell-Rispau, A:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Quintana, MJ:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Univ Autonoma Barcelona, CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Requeijo, C:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Rodriguez-Grijalva, G:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Salas-Gama, K:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Dorantes-Romandia, R:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Salazar, J:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Sola, I:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Univ Autonoma Barcelona, CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Urrutia, G:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Univ Autonoma Barcelona, CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Cosp, XB:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, C St Antoni Maria Claret 167,Pavello 18,Planta 0, Barcelona 08025, Spain
Univ Autonoma Barcelona, CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
gold, Green Published, Green Submitted
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