Zhong Wei, Xue Xiaojun, Dai Lianzhi, Li Ranran, Nie Kai, Zhou Song
Department of General Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian 363000, P.R. China.
Medical Affairs Department, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian 363000, P.R. China.
Exp Ther Med. 2020 Apr;19(4):2604-2614. doi: 10.3892/etm.2020.8494. Epub 2020 Feb 5.
Different neoadjuvant therapy regimens are available for rectal cancer, but the relative effects are controversial. The aim of the present network meta-analysis (NMA) was to estimate the relative efficacy and safety of neoadjuvant therapies for resectable rectal cancer. MEDLINE, EMBASE and Cochrane Central Registry of Controlled Trials were searched for publications dated from 1946 up to June 2018. The present study included randomized clinical trials that compared treatments for resected rectal cancer: Surgery alone, surgery preceded by neoadjuvant radiotherapy (RT), neoadjuvant chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT). Direct pairwise comparisons and NMA were conducted. A total of 23 randomized controlled trials were included in the present study. RT had an overall survival (OS) benefit when compared with surgery alone [HR (hazard ratio), 0.89; 95% confidence interval (CI), 0.82-0.97; quality of evidence, high]. All three neoadjuvant regimens were associated with lower local recurrence (LR) when compared with surgery alone [RT: odds ratio (OR), 0.44; 95% CI, 0.35-0.65; quality of evidence, high; CRT: OR, 0.34; 95% CI, 0.23-0.56; quality of evidence, low and CT: OR, 0.32; 95% CI, 0.11-1.00; quality of evidence, low]. There were no significant differences in OS and LR between CRT and RT (OS: OR, 1.10); 95% CI, 0.93-1.20; LR: OR, 0.81; 95% CI, 0.61-1.10). Ranking probabilities indicated that CRT was the best strategy for local control, with a surface under the cumulative ranking curve (SUCRA) of 78.78%. Patients treated with RT had improved disease-free survival compared with those treated with surgery alone (HR, 0.82; 95% CI, 0.64-1.00; quality of evidence, low). Neoadjuvant RT or CRT did not significantly improve distant metastases compared with surgery alone (RT: OR, 0.87; 95% CI, 0.69-1.10 and CRT: OR, 0.75; 95% CI, 0.47-1.10). CRT had an improved pathological complete response rate compared with RT (OR, 4.90; 95% CI, 21.80-17.00; quality of evidence, low). No significant difference for the risk of anastomotic leak between each treatment was observed in the NMA. In conclusion, RT decreased the LR and improved OS compared with surgery alone for resected rectal cancer. CRT was the best neoadjuvant therapy analyzed and CT was likely the second best for all outcomes based on SUCRA. However, these findings were limited by overall low quality of evidence.
直肠癌有不同的新辅助治疗方案，但相对疗效存在争议。本网状Meta分析（NMA）的目的是评估可切除直肠癌新辅助治疗的相对疗效和安全性。检索MEDLINE、EMBASE和Cochrane对照试验中央注册库中1946年至2018年6月的出版物。本研究纳入了比较可切除直肠癌治疗方法的随机临床试验：单纯手术、新辅助放疗（RT）、新辅助化疗（CT）或新辅助放化疗（CRT）后手术。进行了直接成对比较和NMA。本研究共纳入23项随机对照试验。与单纯手术相比，RT有总生存（OS）获益[风险比（HR），0.89；95%置信区间（CI），0.82 - 0.97；证据质量，高]。与单纯手术相比，所有三种新辅助治疗方案的局部复发（LR）均较低[RT：比值比（OR），0.44；95% CI，0.35 - 0.65；证据质量，高；CRT：OR，0.34；95% CI，0.23 - 0.56；证据质量，低；CT：OR，0.32；95% CI，0.11 - 1.00；证据质量，低]。CRT与RT之间的OS和LR无显著差异（OS：OR，1.10；95% CI，0.93 - 1.20；LR：OR，0.81；95% CI，0.61 - 1.10）。排序概率表明，CRT是局部控制的最佳策略，累积排序曲线下面积（SUCRA）为78.78%。与单纯手术治疗的患者相比，接受RT治疗的患者无病生存期有所改善（HR，0.82；95% CI，0.64 - 1.00；证据质量，低）。与单纯手术相比，新辅助RT或CRT并未显著改善远处转移（RT：OR，0.87；95% CI，0.69 - 1.10；CRT：OR，0.75；95% CI，0.47 - 1.10）。与RT相比，CRT的病理完全缓解率有所提高（OR，4.90；95% CI，2.18 - 17.00；证据质量，低）。NMA中未观察到各治疗组之间吻合口漏风险的显著差异。总之，对于可切除直肠癌，与单纯手术相比，RT降低了LR并改善了OS。基于SUCRA分析，CRT是最佳新辅助治疗，CT可能是所有结局的次优选择。然而，这些发现受到总体证据质量较低的限制。
Zotero 插件
