AP-HP, Department of Oncology, Avicenne Hospital, 125 route de Stalingrad, 93009 Bobigny, France.
Eur J Cancer. 2010 Apr;46(6):1049-55. doi: 10.1016/j.ejca.2010.01.020.
In stage III colorectal cancer (CRC), adjuvant chemotherapy (CT) is usually prescribed within two months after curative surgery. Whether or not delaying initiation of CT affects survival is still debated.
We performed a meta-analysis (MA) of all published studies (full papers or abstracts) comparing delayed CT with standard care. Studies were obtained from a PubMed query (keywords: CRC, adjuvant treatment, delay of CT), a review (Chau et al., 2006), cross-checking references and abstracts from the proceedings of ASCO, ASCO GI and WCGI annual meetings. We chose a cutoff delay of 8 weeks. Risk Ratios (RRs) were calculated from the recorded events (deaths, relapses). We used EasyMA software (fixed-effect model).
Fourteen studies (including four abstracts) were identified (17,645 patients; 5,952 males, 5,151 females, mean age 70 years). Of these, three could not be statistically analysed and three used another cutoff (4, 5 or 6 weeks), leaving 8 studies for main MA (13,158 patients; 3,932 males, 3,644 females, 5,942 missing data; 5,576 colon cancers, 6,677 rectal, 1,265 missing data). Delaying CT more than 8 weeks was associated to worse Overall Survival (OS) (RR: 1.20; 95% Confidence Interval (CI) 1.15-1.26). In the MA including all studies whatever their cutoff, longer delay was similarly associated to a worse OS but not a worse Relapse-Free Survival (RFS) (five studies).
Adjuvant chemotherapy should be started within 8 weeks after surgery. Delaying the initiation of adjuvant CT for more than 8 weeks after surgery significantly decreased OS but not RFS. This discrepancy might be due to factors not directly related to cancer (post-operative complications, social status) or to a more accurate appraisal of death.
在 III 期结直肠癌（CRC）中，辅助化疗（CT）通常在根治性手术后两个月内进行。延迟 CT 起始时间是否会影响生存仍存在争议。
我们对所有已发表的研究（全文或摘要）进行了荟萃分析（MA），比较了延迟 CT 与标准治疗。研究通过 PubMed 查询（关键词：CRC、辅助治疗、CT 延迟）、综述（Chau 等人，2006 年）、交叉检查 ASCO、ASCO GI 和 WCGI 年会的参考文献和摘要获得。我们选择 8 周的截止延迟。风险比（RR）是根据记录的事件（死亡、复发）计算得出的。我们使用 EasyMA 软件（固定效应模型）进行分析。
确定了 14 项研究（包括 4 项摘要）（17645 名患者；5952 名男性，5151 名女性，平均年龄 70 岁）。其中，3 项研究无法进行统计学分析，3 项研究使用了另一个截止值（4、5 或 6 周），因此，8 项研究纳入主要 MA（13158 名患者；3932 名男性，3644 名女性，5942 项缺失数据；5576 例结肠癌，6677 例直肠癌，1265 项缺失数据）。延迟 CT 超过 8 周与总生存（OS）更差相关（RR：1.20；95%置信区间（CI）1.15-1.26）。在包括所有研究的 MA 中，无论其截止值如何，更长的延迟同样与 OS 更差相关，但与无复发生存率（RFS）无差异（5 项研究）。
辅助化疗应在手术后 8 周内开始。手术后 8 周后延迟启动辅助 CT 显著降低了 OS，但未降低 RFS。这种差异可能是由于与癌症无关的因素（术后并发症、社会地位）或对死亡的更准确评估所致。
