局部晚期结肠癌的新辅助治疗：一项荟萃分析与系统评价
Neoadjuvant therapy in locally advanced colon cancer: a meta-analysis and systematic review.
作者信息
Cheong Chin Kai, Nistala Kameswara Rishi Yeshayahu, Ng Cheng Han, Syn Nicholas, Chang Heidi Sian Ying, Sundar Raghav, Yang Soon Yu, Chong Choon Seng
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
出版信息
J Gastrointest Oncol. 2020 Oct;11(5):847-857. doi: 10.21037/jgo-20-220.
BACKGROUND
The role of perioperative or neoadjuvant chemotherapy for locally advanced colon cancer is unclear. Emerging evidence such as the FOXTROT trial is challenging the conventional norm of upfront operation for these patients. However, these trials have yet to reach statistical significance.
METHODS
MEDLINE, Embase, Cochrane Library, China Knowledge Resource Integrated Database (CNKI) and ClinicalTrials.gov were searched. Randomized controlled trials (RCTs) and observational studies of patients with locally advanced colon cancer were included. The intervention arm was neoadjuvant chemotherapies while the comparator arm was adjuvant chemotherapies. Studies which reported outcomes of interests included overall survival, disease-free survival, R0 resection rate, perioperative complications and adverse effects of chemotherapy were chosen.
RESULTS
We identified five eligible randomized trials and two observational studies, including 29,504 patients. Neoadjuvant therapies exhibited statistically significant improvement in overall survival [hazard ratio (HR) =0.76, 95% confidence interval (CI): 0.65-0.89, P=0.0005], and disease-free survival (HR =0.74, 95% CI: 0.58-0.95, P=0.02). R0 resection rate fell slightly short of significance [odds ratio (OR) =1.86, 95% CI: 0.95-3.62, P=0.07]. Risk of peri-operative complications did not differ between groups when examining abdominal infection [risk ratio (RR) =1.14, 95% CI: 0.59-2.18, P=0.70] and anastomotic leakage (RR =0.83, 95% CI: 0.53-1.31, P=0.42). No statistical differences in complications from chemotherapy were reported.
CONCLUSIONS
This meta-analysis highlights the potential survival benefit of neoadjuvant chemotherapy compared to adjuvant chemotherapy for locally advanced colon cancer, without an increase in surgical morbidity. Neoadjuvant or perioperative approaches may be considered an alternative to upfront surgery followed by chemotherapy for locally advanced colon cancer.
背景
围手术期或新辅助化疗在局部晚期结肠癌中的作用尚不清楚。诸如FOXTROT试验等新出现的证据正在挑战这些患者先行手术的传统规范。然而，这些试验尚未达到统计学显著性。
方法
检索了MEDLINE、Embase、Cochrane图书馆、中国知网数据库（CNKI）和ClinicalTrials.gov。纳入了局部晚期结肠癌患者的随机对照试验（RCT）和观察性研究。干预组为新辅助化疗，对照组为辅助化疗。选择报告了包括总生存期、无病生存期、R0切除率、围手术期并发症和化疗不良反应等感兴趣结局的研究。
结果
我们确定了五项符合条件的随机试验和两项观察性研究，包括29504例患者。新辅助治疗在总生存期[风险比（HR）=0.76，95%置信区间（CI）：0.65-0.89，P=0.0005]和无病生存期（HR =0.74，95%CI：0.58-0.95，P=0.02）方面表现出统计学显著改善。R0切除率略未达到显著性[优势比（OR）=1.86，95%CI：0.95-3.62，P=0.07]。在检查腹部感染[风险比（RR）=1.14，95%CI：0.59-2.18，P=0.70]和吻合口漏（RR =0.83，95%CI：0.53-1.31，P=0.42）时，两组围手术期并发症风险无差异。未报告化疗并发症的统计学差异。
结论
这项荟萃分析强调了与辅助化疗相比，新辅助化疗对局部晚期结肠癌具有潜在的生存益处，且手术发病率未增加。新辅助或围手术期方法可被视为局部晚期结肠癌先行手术然后化疗的替代方案。
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