Horesh Nir, Emile Sameh Hany, Garoufalia Zoe, Gefen Rachel, Rogers Peter, Aeschbacher Pauline, Salama Ebram, Wexner Steven D
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Eur J Surg Oncol. 2025 Apr 5;51(8):110019. doi: 10.1016/j.ejso.2025.110019.
This network meta-analysis examined the efficacy of different types of neoadjuvant therapy (NAT) for rectal cancer in improving clinical and pathologic outcomes.
PRISMA-compliant systematic review of PubMed and Scopus including only randomized clinical trials comparing two or more NAT regimens for rectal cancer. A network meta-analysis was undertaken for the main outcomes, including pathological complete response (pCR), disease downstaging, R0 resection, permanent stoma, and major adverse effects. Risk of bias was assessed using the ROB-2 tool.
19 randomized controlled trials incorporating 7037 patients (62 % males) were included in the analysis. Compared to standard neoadjuvant chemoradiation (NCRT), consolidation total neoadjuvant therapy (TNT) (OR: 1.82, 95 % CI: 1.46-2.27; p < 0.001) and induction TNT (OR: 1.72, 95 % CI: 1.31-2.26; p < 0.001) had higher odds of achieving pCR. Induction TNT was also significantly associated with higher odds of major adverse effects than was NCRT (OR: 3.14, 95 % CI: 2.50-3.94; p < 0.0001). Compared to NCRT, long course chemotherapy significantly increased the odds of R0 resection (OR: 1.42, 95 % CI: 1.13-1.78; p = 0.002), while consolidation TNT significantly increased organ preservation rates (OR: 2.82, 95 % CI: 1.58-5.05; p < 0.001). Short course radiotherapy doubled the odds of positive circumferential resection margins (CRM) compared to NCRT (OR: 1.99, 95 % CI: 1.11-3.55; p = 0.02).
Consolidation and induction TNT were superior in achieving better pathological outcomes in rectal cancer, offering significant benefits over standard NCRT. However, they were associated with a higher risk of adverse effects. Conversely, short course radiotherapy was linked to higher rates of positive CRM.
本网络荟萃分析探讨了不同类型的新辅助治疗（NAT）对直肠癌改善临床和病理结局的疗效。
按照PRISMA标准对PubMed和Scopus进行系统综述，仅纳入比较两种或更多种直肠癌NAT方案的随机临床试验。对主要结局进行网络荟萃分析，包括病理完全缓解（pCR）、疾病降期、R0切除、永久性造口和主要不良反应。使用ROB-2工具评估偏倚风险。
分析纳入了19项随机对照试验，共7037例患者（62%为男性）。与标准新辅助放化疗（NCRT）相比，巩固性全新辅助治疗（TNT）（比值比：1.82，95%置信区间：1.46 - 2.27；p < 0.001）和诱导性TNT（比值比：1.72，95%置信区间：1.31 - 2.26；p < 0.001）达到pCR的几率更高。与NCRT相比，诱导性TNT出现主要不良反应的几率也显著更高（比值比：3.14，95%置信区间：2.50 - 3.94；p < 0.0001）。与NCRT相比，长程化疗显著增加了R0切除的几率（比值比：1.42，95%置信区间：1.13 - 1.78；p = 0.002），而巩固性TNT显著提高了器官保留率（比值比：2.82，95%置信区间：1.58 - 5.05；p < 0.001）。与NCRT相比，短程放疗使环周切缘阳性（CRM）的几率增加了一倍（比值比：1.99，95%置信区间：1.11 - 3.55；p = 0.02）。
巩固性和诱导性TNT在直肠癌中实现更好的病理结局方面更具优势，比标准NCRT有显著益处。然而，它们与更高的不良反应风险相关。相反，短程放疗与更高的CRM阳性率有关。
