Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients.

Autor: de Moraes FCA; Federal University of Pará, Rua Augusto Corrêa, nº 01, Guamá, Belém, Pará, 66073-000, Brazil. francisco.cezar2205@gmail.com., Kelly FA; Department of Hypertension, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil., Souza MEC; University of Pernambuco, Recife, Pernambuco, Brazil., Burbano RMR; Federal University of Pará, Rua Augusto Corrêa, nº 01, Guamá, Belém, Pará, 66073-000, Brazil.; Ophir Loyola Hospital, Belém, Pará, Brazil.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2024 Jun 24; Vol. 39 (1), pp. 96. Date of Electronic Publication: 2024 Jun 24.
DOI: 10.1007/s00384-024-04668-x
Abstrakt: 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 I 2 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; I 2  = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21-2.24; p = 0.001; I 2  = 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; I 2  = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82-1.74; p = 0.36; I 2  = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87-1.40; p = 0.39; I 2  = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78-1.51; p = 0.62; I 2  = 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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