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- Title
Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients.
- Authors
de Moraes, Francisco Cezar Aquino; Kelly, Francinny Alves; Souza, Maria Eduarda Cavalcanti; Burbano, Rommel Mario Rodríguez
- Abstract
Background: Locally advanced rectal cancer (LARC) typically involves neoadjuvant chemoradiotherapy (nCRT) followed by surgery (total mesorectal excision, TME). While achieving a complete pathological response (pCR) is a strong indicator of a positive prognosis, the specific benefits of adjuvant chemotherapy after pCR remain unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to assess the potential advantages of adjuvant therapy in patients who achieve pCR. Methods: In this study, we searched Medline, Embase, and Web of Science databases for relevant research. We focused on binary outcomes, analyzing them using odds ratios (ORs) with 95% confidence intervals (CIs). To account for potential variability between studies, all endpoints were analyzed with DerSimonian and Laird random-effects models. We assessed heterogeneity using the I2 statistic and employed the R statistical software (version 4.2.3) for all analyses. Results: Thirty-four studies, comprising 31,558 patients, were included. The outcomes demonstrated a significant difference favoring the AC group in terms of overall survival (OS) (HR 0.75; 95% CI 0.60–0.94; p = 0.015; I2 = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21–2.24; p = 0.001; I2 = 39%). There was no significant difference between the groups for disease-free survival (DFS) (HR 0.94; 95% CI 0.76–1.17; p = 0.61; I2 = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82–1.74; p = 0.36; I2 = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87–1.40; p = 0.39; I2 = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78–1.51; p = 0.62; I2 = 0%). Conclusion: This systematic review and meta-analysis found a significant difference in favor of the ACT group in terms of survival after pCR. Therefore, the administration of this treatment as adjuvant therapy should be encouraged in clinical practice.
- Subjects
RECTAL cancer; ADJUVANT chemotherapy; WEB databases; SCIENCE databases; OVERALL survival; PROGRESSION-free survival; RECTAL surgery
- Publication
International Journal of Colorectal Disease, 2024, Vol 39, Issue 1, p1
- ISSN
0179-1958
- Publication type
Article
- DOI
10.1007/s00384-024-04668-x