Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis
| Autor: | G. Des Guetz, J.-F. Morere, Bernard Uzzan, Patrick Nicolas, Gérard-Yves Perret |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Oncology
Male Cancer Research medicine.medical_specialty Time Factors Adjuvant chemotherapy Colorectal cancer medicine.medical_treatment Standard care Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Survival analysis Aged Chemotherapy business.industry Cancer medicine.disease Survival Analysis Confidence interval Surgery Chemotherapy Adjuvant Relative risk Meta-analysis Curative surgery Female Colorectal Neoplasms business Adjuvant |
| Zdroj: | European Journal of Cancer. 46:1049-1055 |
| ISSN: | 0959-8049 |
| DOI: | 10.1016/j.ejca.2010.01.020 |
| Popis: | Background In stage III colorectal cancer (CRC), adjuvant chemotherapy (CT) is usually prescribed within two months after curative surgery. Whether or not delaying initiation of CT affects survival is still debated. Material and methods We performed a meta-analysis (MA) of all published studies (full papers or abstracts) comparing delayed CT with standard care. Studies were obtained from a PubMed query (keywords: CRC, adjuvant treatment, delay of CT), a review (Chau et al., 2006), cross-checking references and abstracts from the proceedings of ASCO, ASCO GI and WCGI annual meetings. We chose a cutoff delay of 8 weeks. Risk Ratios (RRs) were calculated from the recorded events (deaths, relapses). We used EasyMA software (fixed-effect model). Results Fourteen studies (including four abstracts) were identified (17,645 patients; 5952 males, 5151 females, mean age 70 years). Of these, three could not be statistically analysed and three used another cutoff (4, 5 or 6 weeks), leaving 8 studies for main MA (13,158 patients; 3932 males, 3644 females, 5942 missing data; 5576 colon cancers, 6677 rectal, 1265 missing data). Delaying CT more than 8 weeks was associated to worse Overall Survival (OS) (RR: 1.20; 95% Confidence Interval (CI) 1.15–1.26). In the MA including all studies whatever their cutoff, longer delay was similarly associated to a worse OS but not a worse Relapse-Free Survival (RFS) (five studies). Conclusion Adjuvant chemotherapy should be started within 8 weeks after surgery. Delaying the initiation of adjuvant CT for more than 8 weeks after surgery significantly decreased OS but not RFS. This discrepancy might be due to factors not directly related to cancer (post-operative complications, social status) or to a more accurate appraisal of death. |
| Databáze: | OpenAIRE |
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