Noronha Mariana Macambira, Costa Almeida Luiz F, Cappellaro Anelise Poluboiarinov, Silva Luís Felipe Leite da, Conceição Lucas Diniz da, Menezes Junior Samuel Alonso de, Belotto Marcos, Peixoto Renata D 'Alpino
Department of Medical Sciences, Universidade Federal do Ceará, CE, Brazil.
Department of Medical Sciences, Universidade Federal Fluminense, RJ, Brazil.
Eur J Cancer. 2025 Jun 3;222:115476. doi: 10.1016/j.ejca.2025.115476. Epub 2025 Apr 25.
Neoadjuvant chemotherapy (NAC) treatment has appeared as a promising alternative to upfront surgery to improve efficacy outcomes in non-metastatic colon cancer, but the findings are still controversial. Considering this ongoing debate, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the benefit of NAC in high-risk stage II and stage III colon cancer.
We searched PubMed, Embase, and Cochrane for clinical trials evaluating NAC in non-metastatic colon cancer. Random and fixed effects models were employed for statistical analyses in Review Manager software version 5.4. Moreover, to evaluate the heterogeneity, I statistics were used.
A total of 1248 patients from 4 clinical trials were included. The NAC group demonstrated a 38 % reduction in the risk of death. (HR 0.62; 95 % CI 0.41-0.92; I = 0 %), and a 21 % reduction in the risk of disease recurrence (HR 0.79; 95 % CI 0.65-0.96; I = 0 %). Additionally, the NAC group had higher R0 resection, with an increase of 80 % in the odds compared to upfront surgery (OR 1.80; 95 % CI 1.24-2.61; I² = 0 %). Pathological complete response and major pathologic response (PCR) were achieved in 5.9.% % and 36.2 %, respectively. Patients with proficient mismatch repair achieved a higher PCR rate and a consistent reduction in the risk of recurrence compared to the overall population, with proportions of 6.3 % and 32 %, respectively. Also, there was no significant addition to the toxicity profile in the NAC arm.
Our systematic review and meta-analysis support the feasibility and survival benefits of neoadjuvant chemotherapy for high-risk stage II and III colon cancer.
新辅助化疗（NAC）作为一种有前景的替代 upfront 手术的治疗方法，已出现用于改善非转移性结肠癌的疗效结果，但研究结果仍存在争议。考虑到这一持续的争论，我们对随机对照试验进行了系统评价和荟萃分析，以评估 NAC 在高危 II 期和 III 期结肠癌中的益处。
我们在 PubMed、Embase 和 Cochrane 中检索了评估 NAC 在非转移性结肠癌中的临床试验。在 Review Manager 软件 5.4 版中采用随机和固定效应模型进行统计分析。此外，为评估异质性，使用了 I 统计量。
共纳入来自 4 项临床试验的 1248 例患者。NAC 组的死亡风险降低了 38%（HR 0.62；95%CI 0.41 - 0.92；I² = 0%），疾病复发风险降低了 21%（HR 0.79；95%CI 0.65 - 0.96；I² = 0%）。此外，NAC 组的 R0 切除率更高，与 upfront 手术相比，优势比增加了 80%（OR 1.80；95%CI 1.24 - 2.61；I² = = 0%）。病理完全缓解和主要病理缓解（PCR）分别达到 5.9%和 36.2%。与总体人群相比，错配修复功能正常的患者实现了更高的 PCR 率和复发风险的持续降低，比例分别为 6.3%和 32%。此外，NAC 组的毒性特征没有显著增加。
我们的系统评价和荟萃分析支持新辅助化疗用于高危 II 期和 III 期结肠癌的可行性和生存益处。
