Ma Zhou, Tan Ling, Liu Zi-Lin, Xiao Jiang-Wei
Department of Gastrointestinal Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Department of Gastrointestinal Surgery, BaZhong Central Hospital, Bazhong, China.
Front Surg. 2022 Aug 26;9:911538. doi: 10.3389/fsurg.2022.911538. eCollection 2022.
The effectiveness of total neoadjuvant therapy (TNT) on patients with locally advanced rectal cancer (LARC) is controversy. This study aims to compare the prognostic value of TNT with standard neoadjuvant chemoradiotherapy (CRT) for LARC.
We searched databases (Embase [Ovid], Medline [Ovid], PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and March 10, 2022. Studies on evaluating the effects of TNT and standard CRT on the prognosis of LARC were included. The primary outcomes were overall survival (OS) and disease-free survival (DFS).
19 primary studies, involving 10 randomized controlled trials, 3 prospective studies and 6 retrospective studies, with data on 5,074 patients treated for LARC were included in the meta-analysis. Statistical analyses revealed that, compared with standard CRT, TNT significantly improved OS (hazard ratio [HR]=0.77, 95% confidence interval [CI]=0.65-0.90, = 30%, = 0.17), DFS (HR = 0.85, 95% CI = 0.74-0.97, ² = 11%, = 0.35), distant metastases-free survival (DMFS, HR = 0.76, 95% CI = 0.65-0.90, ² = 0%, = 0.50), pathological complete response rate (pCR, OR = 1.89, 95% CI = 1.61-2.22, ² = 0%, = 0.47), and R0 resection rate (OR = 1.33, 95% CI = 1.07-1.67, I² = 16%, = 0.28), but local recurrence-free survival (LRFS, HR = 1.12, 95% CI = 0.90-1.39, ² = 4%, = 0.37).
Comprehensive literature research shows that TNT showed excellent short-term efficacy in terms of pCR and R0 resection rate while also improved the long-term outcomes of OS, DFS and DMFS, might become a new standard of treatment in patients with LARC. Even so, more studies and longer follow-up were still warranted.
全新辅助治疗（TNT）对局部晚期直肠癌（LARC）患者的疗效存在争议。本研究旨在比较TNT与标准新辅助放化疗（CRT）对LARC的预后价值。
我们检索了数据库（Embase [Ovid]、Medline [Ovid]、PubMed、Cochrane图书馆和Web of Science）中2000年1月1日至2022年3月10日发表的文章。纳入评估TNT和标准CRT对LARC预后影响的研究。主要结局为总生存期（OS）和无病生存期（DFS）。
荟萃分析纳入了19项主要研究，包括10项随机对照试验、3项前瞻性研究和6项回顾性研究，涉及5074例接受LARC治疗的患者的数据。统计分析显示，与标准CRT相比，TNT显著改善了OS（风险比[HR]=0.77，95%置信区间[CI]=0.65 - 0.90， = 30%， = 0.17）、DFS（HR = 0.85，95% CI = 0.74 - 0.97，² = 11%， = 0.35）、远处转移无进展生存期（DMFS，HR = 0.76，95% CI = 0.65 - 0.90，² = 0%， = 0.50）、病理完全缓解率（pCR，OR = 1.89，95% CI = 1.61 - 2.22，² = 0%， = 0.47）和R0切除率（OR = 1.33，95% CI = 1.07 - 1.67，I² = 16%， = 0.28），但局部复发无进展生存期（LRFS，HR = 1.12，95% CI = 0.90 - 1.39，² = 4%， = 0.37）。
综合文献研究表明，TNT在pCR和R0切除率方面显示出优异的短期疗效，同时也改善了OS、DFS和DMFS的长期结局，可能成为LARC患者的新治疗标准。即便如此，仍需要更多研究和更长时间的随访。
