新辅助放化疗后病理完全缓解的直肠癌患者辅助化疗作用的现有证据：系统评价和荟萃分析。
Current evidence regarding the role of adjuvant chemotherapy in rectal cancer patients with pathologic complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.
机构信息
Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece.
出版信息
Int J Colorectal Dis. 2021 Jul;36(7):1395-1406. doi: 10.1007/s00384-021-03915-9. Epub 2021 Mar 27.
PURPOSE
The aim of this meta-analysis was to investigate the role of adjuvant chemotherapy (AC) in rectal cancer patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) and curative resection.
METHODS
This study was completed in accordance to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened for eligible articles. The level of evidence (LoE) was assessed using the GRADE methodology.
RESULTS
Overall, 23 non-randomized studies and 17,406 patients were included in the present meta-analysis. Pooled comparisons confirmed that AC improved overall survival (HR: 0.68, p=0.0003), but not disease-free (p=0.22) and recurrence-free survival (p=0.39). However, the LoE for all outcomes was characterized as "very low," due to the absence of RCTs.
CONCLUSIONS
Considering the study limitations and the lack of randomized studies, further high-quality RCTs are required to confirm the findings of our study.
目的
本荟萃分析旨在探讨新辅助放化疗（nCRT）和根治性切除术后病理完全缓解（pCR）的直肠患者辅助化疗（AC）的作用。
方法
本研究按照 PRISMA 指南和 Cochrane 干预系统评价手册进行。电子学者数据库（Medline、Web of Science、Scopus）对合格文献进行筛选。使用 GRADE 方法评估证据水平（LoE）。
结果
本荟萃分析共纳入 23 项非随机研究和 17406 例患者。汇总比较证实，AC 可提高总生存率（HR：0.68，p=0.0003），但不能改善无病生存率（p=0.22）和无复发生存率（p=0.39）。然而，由于缺乏 RCT，所有结局的 LoE 均为“极低”。
结论
鉴于研究的局限性和缺乏随机研究，需要进一步开展高质量的 RCT 来证实本研究的结果。
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