Background: Alternatives in treatment-strategies exist for resectable gastric cancer. Our aims were: (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized-controlled-trials on the curative treatment of resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant chemo(radio)therapy regimens, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95% CrIs). Results: NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9714 patients). Compared to taxane-based-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95% CrI = 0.38–0.91) and perioperative-chemotherapy regimens without a taxane (HR = 0.79, 95% CrI = 0.58–1.15) were inferior in OS. After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95% CrI = 0.28–0.80). Conclusions: For resectable gastric cancer, (1) taxane-based perioperative-chemotherapy was the most promising treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine was the most promising regimen after curative resection. More research is warranted to confirm or reproach these findings.

Background: 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. Methods: 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 (p < 0.05) in a multivariate analysis, (2) reported in at least 250 patients, and (3) p < 0.05, in ≥33% of the total number of patients in RCTs reporting this factor. Predictive factors were potentially clinically-relevant if (1) the p-value for interaction between subgroups was <0.20 and (2) the hazard ratio in one of the subgroups was significant (p < 0.05). Results: For gastric cancer, 39 RCTs were identified (n = 13,530 patients) and, for esophageal cancer, 33 RCTs were identified (n = 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. Conclusion: 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.

Aims: A considerable proportion of patients develop long-term sequelae after an acute pulmonary embolism (PE). Beyond chronic thrombo-embolic pulmonary hypertension (CTEPH), current guidelines provide limited guidance regarding a structured approach for assessment and management of these patients. This study aimed to establish a framework of multidisciplinary follow-up care of PE-survivors. Methods and results: A Delphi study was conducted among a multidisciplinary panel of PE specialists from across Europe to gather expert opinions, and where possible reach consensus, on key aspects of PE follow-up care. Two rounds of surveys were distributed among 45 venous thromboembolism (VTE) experts, with 39 completing both rounds. Consensus was reached that follow-up of PE survivors should address the entire spectrum of post-PE sequelae, i.e. CTEPH, chronic thromboembolic pulmonary disease, but also all other presentations of the post-PE syndrome. Routine assessment at 3 months should involve patient-reported outcome measures, including quality of life. A single, uniform protocol was preferred over locally adapted approaches. Earlier follow-up, prior to the 3-month mark, to detect post-PE sequelae was not considered necessary for most patient subgroups. Right heart catheterization to confirm CTEPH should be reserved for specialized pulmonary hypertension centres, while other diagnostic modalities such as computed tomography, V/Q scan, cardiopulmonary exercise testing and transthoracic echocardiography can be performed in non-referral centres. Conclusion: This Delphi study among a panel of VTE experts across Europe describes a consensus-based framework for structured follow-up care for PE-survivors, emphasizing the need for a standardized, multidisciplinary approach to detecting long-term sequelae of PE.

Background: Alternatives in treatment-strategies exist for resectable gastric cancer treated with curative intent including: perioperative chemotherapy, adjuvant chemoradiotherapy and adjuvant chemotherapy. Our aims were (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent.