Ma Bin, Ren Yupeng, Chen Yue, Lian Bo, Jiang Peng, Li Yongmin, Shang Yan, Meng Qingkai
Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
Int J Colorectal Dis. 2019 Jan;34(1):113-121. doi: 10.1007/s00384-018-3181-9. Epub 2018 Oct 27.
Current clinical guidelines recommended the routine use of adjuvant chemotherapy for locally advanced rectal cancer (LARC) patients. However, the effects of adjuvant chemotherapy in patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy and radical surgery showed discrepancies in different investigations.
A systematic review and meta-analysis were conducted using PubMed, Embase and Web of Science databases. All original comparative studies published in English that were related to adjuvant versus non-adjuvant chemotherapy for LARC patients with pCR were included.
A total of 6 studies based on 18 centres or databases involving 2948 rectal cancer patients with pCR (adjuvant group = 1324, non-adjuvant group = 1624) were included in our overall analysis. Based on our meta-analysis, LARC patients with pCR who received adjuvant chemotherapy showed a significantly improved overall survival (OS) when compared to patients with observation (HR = 0.65, 95% CI = 0.46-0.90, P = 0.01). In addition, investigations focused on this issue based on the National Cancer Database (NCDB) were systematically reviewed in our current study. Evidence from all three analyses demonstrated that LARC patients with clinical nodal positive disease that achieved pCR might benefit the most from additional adjuvant chemotherapy.
Our meta-analysis indicated that adjuvant chemotherapy is associated with improved OS in LARC patients with pCR after neoadjuvant chemoradiotherapy and radical surgery.
当前临床指南推荐对局部晚期直肠癌（LARC）患者常规使用辅助化疗。然而，新辅助放化疗及根治性手术后病理完全缓解（pCR）患者接受辅助化疗的效果在不同研究中存在差异。
使用PubMed、Embase和Web of Science数据库进行系统评价和荟萃分析。纳入所有以英文发表的、与pCR的LARC患者辅助化疗与非辅助化疗相关的原始对照研究。
我们的总体分析纳入了共6项基于18个中心或数据库的研究，涉及2948例pCR直肠癌患者（辅助化疗组 = 1324例，非辅助化疗组 = 1624例）。基于我们的荟萃分析，与接受观察的患者相比，接受辅助化疗的pCR的LARC患者总生存期（OS）显著改善（HR = 0.65，95%CI = 0.46 - 0.90，P = 0.01）。此外，在我们当前的研究中对基于美国国立癌症数据库（NCDB）针对此问题的研究进行了系统评价。所有三项分析的证据均表明，临床淋巴结阳性疾病且达到pCR的LARC患者可能从额外的辅助化疗中获益最大。
我们的荟萃分析表明，辅助化疗与新辅助放化疗及根治性手术后pCR的LARC患者OS改善相关。
