Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, Australia; Department of Surgical Specialties, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Department of Surgery, Colorectal Unit, Royal Adelaide Hospital, Adelaide, Australia; Department of Surgical Specialties, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Clin Colorectal Cancer. 2024 Dec;23(4):326-336.e9. doi: 10.1016/j.clcc.2024.06.001. Epub 2024 Jun 11.
TNT is now considered the preferred option for stage II-III locally advanced rectal cancer (LARC). However, the prognostic benefit and optimal sequence of TNT remains unclear. This network meta-analysis (NMA) compared short- and long-term outcomes amongst patients with LARC receiving total neoadjuvant therapy (TNT) as induction (iTNT) or consolidation chemotherapy (cTNT) with those receiving neoadjuvant chemoradiation (nCRT) alone. A systematic literature search was performed between 2012 and 2023. A Bayesian NMA was conducted using a Markov Chain Monte Carlo method with a random-effects model and vague prior distribution to calculate odds ratios (OR) with 95% credible intervals (CrI). The surface under the cumulative ranking (SUCRA) curves were used to rank treatment(s) for each outcome. In total, 11 cohorts involving 8360 patients with LARC were included. There was no significant difference in disease-free survival (DFS) and overall survival (OS) amongst the 3 treatments. Compared with nCRT, both cTNT (OR 2.36; 95% CrI, 1.57-3.66) and iTNT (OR 1.99; 95% CrI, 1.44-2.95) significantly improved complete response (CR) rate. Notably, cTNT ranked as the best treatment for CR (SUCRA 0.90) and iTNT as the best treatment for 3-year DFS and OS (SUCRA 0.72 and 0.87, respectively). Both iTNT and cTNT strategies significantly improved CR rates compared with nCRT. cTNT was ranked highest for CR rates, while iTNT was ranked highest for 3-year survival outcomes. However, no other significant differences in DFS, OS, sphincter-saving surgery, R0 resection and postoperative complications were found amongst the treatment groups.
TNT 现在被认为是 II-III 期局部进展期直肠癌（LARC）的首选治疗方案。然而，TNT 的预后获益和最佳治疗顺序仍不清楚。本项网状荟萃分析（NMA）比较了接受诱导性新辅助全直肠系膜切除术（iTNT）或巩固性化疗（cTNT）的 LARC 患者与单独接受新辅助放化疗（nCRT）的患者的短期和长期结局。对 2012 年至 2023 年的文献进行了系统检索。采用贝叶斯 NMA，使用马尔可夫链蒙特卡罗法和随机效应模型，采用模糊先验分布，计算比值比（OR）及其 95%可信区间（CrI）。采用累积排序概率曲线（SUCRA）来评估每种结局的治疗方法的排序。共纳入了 11 项涉及 8360 例 LARC 患者的队列研究。3 种治疗方法在无病生存率（DFS）和总生存率（OS）方面无显著差异。与 nCRT 相比，cTNT（OR 2.36；95%CrI，1.57-3.66）和 iTNT（OR 1.99；95%CrI，1.44-2.95）均显著提高了完全缓解（CR）率。值得注意的是，cTNT 在 CR 方面的排名最高（SUCRA 0.90），iTNT 在 3 年 DFS 和 OS 方面的排名最高（SUCRA 分别为 0.72 和 0.87）。与 nCRT 相比，iTNT 和 cTNT 策略均显著提高了 CR 率。cTNT 在 CR 率方面排名最高，而 iTNT 在 3 年生存结局方面排名最高。然而，在 DFS、OS、保肛手术、R0 切除和术后并发症方面，各组之间没有发现其他显著差异。
