van den Berg K, van Hellemond I E G, Willems J M W E, Burger J W A, Rutten H J T, Creemers G J
Department of Medical Oncology, Catharina Hospital, Eindhoven, Netherlands; Department of Surgery, Catharina Hospital, Eindhoven, Netherlands.
Department of Medical Oncology, Catharina Hospital, Eindhoven, Netherlands.
Eur J Surg Oncol. 2025 Mar;51(3):109560. doi: 10.1016/j.ejso.2024.109560. Epub 2024 Dec 20.
Neoadjuvant chemotherapy is suggested in locally advanced colon cancer. Data on improved long-term oncological outcomes are lacking, which hampers the implementation in clinical practice. This systematic review provides an overview of the benefits and drawbacks of neoadjuvant chemotherapy in patients with locally advanced colon cancer. A systematic literature search was performed using Embase (OVID), MEDLINE (OvidSP), and the Cochrane Library. Studies reporting on the efficacy of neoadjuvant chemotherapy in patients with operable, locally advanced colon cancer without metastases at the time of diagnosis were considered eligible for inclusion. An overview of short- and long-term outcomes of neoadjuvant chemotherapy is provided based on available literature. Additionally, proportional meta-analyses were performed using MedCalc Statistical Software version 19.2.6. A total of 17 unique studies were included in this review, 3 randomised controlled trials and 14 prospective single-arm or retrospective studies. The maximum reported dropout before surgery was 7.8 % in the neoadjuvant chemotherapy group. A histopathological complete response after neoadjuvant chemotherapy was observed in 0-4.8 % of the patients. The occurrence of anastomotic leaks was less than 8 % for both patients treated with neoadjuvant chemotherapy and patients treated with upfront surgery. Neoadjuvant chemotherapy is a safe alternative for adjuvant chemotherapy based on the dropout rate before surgery and the peri-operative morbidity and peri-operative mortality. Robust long-term survival outcomes are lacking and serious concerns regarding the risk of overtreatment have been expressed. Hence, neoadjuvant chemotherapy might be considered in a select group of patients with locally advanced colon cancer.
对于局部晚期结肠癌，建议进行新辅助化疗。目前缺乏关于改善长期肿瘤学结局的数据，这阻碍了其在临床实践中的应用。本系统评价概述了新辅助化疗在局部晚期结肠癌患者中的利弊。使用Embase（OVID）、MEDLINE（OvidSP）和Cochrane图书馆进行了系统的文献检索。报道新辅助化疗对可手术的、诊断时无转移的局部晚期结肠癌患者疗效的研究被认为符合纳入标准。根据现有文献，提供了新辅助化疗的短期和长期结局概述。此外，使用MedCalc统计软件版本19.2.6进行了比例荟萃分析。本评价共纳入17项独特研究，3项随机对照试验和14项前瞻性单臂或回顾性研究。新辅助化疗组术前报告的最大失访率为7.8%。新辅助化疗后，0-4.8%的患者出现组织病理学完全缓解。新辅助化疗组患者和直接手术组患者的吻合口漏发生率均低于8%。基于术前失访率、围手术期发病率和围手术期死亡率，新辅助化疗是辅助化疗的一种安全替代方案。目前缺乏有力的长期生存结局数据，且已有人对过度治疗风险表示严重担忧。因此，对于一小部分局部晚期结肠癌患者，可以考虑新辅助化疗。
