Compare clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Meta-analysis

被引:0
作者
Wang, Ying [1 ]
Yang, Yan [2 ]
Liu, Qi-Qi [3 ]
Wang, Shao-Zhao [4 ]
机构
[1] Feicheng Peoples Hosp, Dept Anus Intestinal Surg, Feicheng 271600, Shandong, Peoples R China
[2] Univ Hlth & Rehabil Sci, Qingdao Hosp, Qingdao Municipal Hosp, Dept Gastroenterol, Qingdao 266011, Shandong, Peoples R China
[3] Peking Univ, Shenzhen Hosp, Dept Gastrointestinal Surg, Shenzhen 518036, Guangdong, Peoples R China
[4] Shandong First Med Univ, Cent Hosp Affiliated, Dept Anorectal Words, 105 Jiefang Rd, Jinan 250013, Shandong, Peoples R China
来源
WORLD JOURNAL OF GASTROINTESTINAL SURGERY | 2024年 / 16卷 / 06期
关键词
Neoadjuvant therapy; Neoadjuvant chemoradiotherapy; Advanced rectal cancer; Clinical efficacy; Meta-analysis; PREOPERATIVE CHEMORADIATION; CONSOLIDATION CHEMOTHERAPY; SURVIVAL; SURGERY; PERIOD; TRIAL;
D O I
10.4240/wjgs.v16.i6.1845
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND To compare the efficacy and safety of total neoadjuvant therapy (TNT) and neoadjuvant chemoradiotherapy (nCRT) in the treatment of middle and low locally advanced rectal cancer. Our study will systematically collect and integrate studies to evaluate the ability of these two treatments to improve tumor shrinkage rates, surgical resection rates, tumor-free survival, and severe adverse events. AIM To provide clinicians and patients with more reliable treatment options to optimize treatment outcomes and quality of life for patients with locally advanced rectal cancer by comparing the advantages and disadvantages of the two treatment options. METHODS A full search of all clinical studies on the effectiveness and safety of TNT and nCRT for treating locally advanced rectal cancer identified in Chinese (CNKI, Wanfang, China Biomedical Literature Database) and English (PubMed, Embase) databases was performed. Two system assessors independently screened the studies according to the inclusion and exclusion criteria. Quality evaluation and data extraction were performed for the included literature. We used RevMan 5.3 software to perform a meta-analysis of the pathologic complete response (pCR) rate, T stage degradation rate, resection 0 (R0) rate, anal grade 3/4 acute toxicity rate, perioperative complications, overall survival (OS), and disease-free survival (DFS) in the TNT and nCRT groups. RESULTS Finally, 14 studies were included, six of which were randomized controlled studies. A total of 3797 patients were included, including 1865 in the TNT group and 1932 in the nCRT group. The two sets of baseline data were comparable. The results of the meta-analysis showed that the pCR rate [odds ratio (OR) = 1.57, 95% confidence interval (CI): 1.30-1.90, P < 0.00001], T stage degradation rate (OR = 2.16, 95%CI: 1.63-2.57, P < 0.00001), and R0 resection rate (OR = 1.42, 95%CI: 1.09-1.85, P = 0.009) were significantly greater in the nCRT group than in the nCRT group. There was no significant difference in the incidence of grade 3/4 acute toxicity or perioperative complications between the two groups. The 5-year OS [hazard ratio (HR) = 0.84, 95%CI: 0.69-1.02, P = 0.08] and DFS (HR = 0.94, 95%CI: 0.03-1.39, P = 0.74) of the TNT group were similar to those of the nCRT group. CONCLUSION TNT has greater clinical efficacy and safety than nCRT in the treatment of locally advanced rectal cancer.
引用
收藏
页数:13
相关论文
共 44 条
[1]   MR imaging for rectal cancer: the role in staging the primary and response to neoadjuvant therapy [J].
Battersby, Nick J. ;
Moran, Brendan ;
Yu, Stanley ;
Tekkis, Paris ;
Brown, Gina .
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY, 2014, 8 (06) :703-719
[2]   Clinical and biochemical predictors of tumor response after neoadjuvant therapy in rectal cancer [J].
Bedrikovetski, Sergei ;
Traeger, Luke ;
Vather, Ryash ;
Moore, James W. ;
Sammour, Tarik .
ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, 2023, 19 (03) :365-373
[3]  
Bhatti Abu Bakar Hafeez, 2015, Asian Pac J Cancer Prev, V16, P2993
[4]   Neoadjuvant Therapy for Locally Advanced Rectal Cancer: Recent Advances and Ongoing Challenges [J].
Body, Amy ;
Prenen, Hans ;
Lam, Marissa ;
Davies, Amy ;
Tipping-Smith, Samuel ;
Lum, Caroline ;
Liow, Elizabeth ;
Segelov, Eva .
CLINICAL COLORECTAL CANCER, 2021, 20 (01) :29-41
[5]   Total neoadjuvant treatment and organ preservation strategies in the management of localized rectal cancer: A narrative review and evidence-based algorithm [J].
Borelli, Beatrice ;
Germani, Marco Maria ;
Carullo, Martina ;
Mattioni, Roberto ;
Manfredi, Bruno ;
Sainato, Aldo ;
Rossi, Piercarlo ;
Vagli, Paola ;
Balestri, Riccardo ;
Buccianti, Piero ;
Morelli, Luca ;
Antoniotti, Carlotta ;
Cremolini, Chiara ;
Masi, Gianluca ;
Moretto, Roberto .
CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2023, 186
[6]   Total neoadjuvant therapy in rectal cancer: the evidence and expectations [J].
Boublikova, Ludmila ;
Novakova, Alena ;
Simsa, Jaromir ;
Lohynska, Radka .
CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2023, 192
[7]   Long-course oxaliplatin-based preoperative chemoradiation versus 5 x 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study [J].
Bujko, K. ;
Wyrwicz, L. ;
Rutkowski, A. ;
Malinowska, M. ;
Pietrzak, L. ;
Krynski, J. ;
Michalski, W. ;
Oledzki, J. ;
Kusnierz, J. ;
Zajac, L. ;
Bednarczyk, M. ;
Szczepkowski, M. ;
Tarnowski, W. ;
Kosakowska, E. ;
Zwolinski, J. ;
Winiarek, M. ;
Wisniowska, K. ;
Partycki, M. ;
Beczkowska, K. ;
Polkowski, W. ;
Stylinski, R. ;
Wierzbicki, R. ;
Bury, P. ;
Jankiewicz, M. ;
Paprota, K. ;
Lewicka, M. ;
Cisel, B. ;
Skorzewska, M. ;
Mielko, J. ;
Bebenek, M. ;
Maciejczyk, A. ;
Kapturkiewicz, B. ;
Dybko, A. ;
Hajac, L. ;
Wojnar, A. ;
Lesniak, T. ;
Zygulska, J. ;
Jantner, D. ;
Chudyba, E. ;
Zegarski, W. ;
Las-Jankowska, M. ;
Jankowski, M. ;
Kolodziejski, L. ;
Radkowski, A. ;
Zelazowska-Omiotek, U. ;
Czeremszynska, B. ;
Kepka, L. ;
Kolb-Sielecki, J. ;
Toczko, Z. ;
Fedorowicz, Z. .
ANNALS OF ONCOLOGY, 2016, 27 (05) :834-842
[8]  
Calvo FA, 2014, STRAHLENTHER ONKOL, V190, P149, DOI 10.1007/s00066-013-0469-0
[9]   Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer [J].
Cercek, Andrea ;
Roxburgh, Campbell S. D. ;
Strombom, Paul ;
Smith, J. Joshua ;
Temple, Larissa K. F. ;
Nash, Garrett M. ;
Guillem, Jose G. ;
Paty, Philip B. ;
Yaeger, Rona ;
Stadler, Zsofia K. ;
Seier, Kenneth ;
Gonen, Mithat ;
Segal, Neil H. ;
Reidy, Diane L. ;
Varghese, Anna ;
Shia, Jinru ;
Vakiani, Efsevia ;
Wu, Abraham J. ;
Crane, Christopher H. ;
Gollub, Marc J. ;
Garcia-Aguilar, Julio ;
Saltz, Leonard B. ;
Weiser, Martin R. .
JAMA ONCOLOGY, 2018, 4 (06)
[10]  
De Felice F, 2022, CLIN COLORECTAL CANC, V21, pE21, DOI 10.1016/j.clcc.2021.11.005