Is total neoadjuvant treatment beneficial for locally advanced rectal cancer? a meta-analysis of randomized controlled trials

被引:1
|
作者
Wu, Hai-Qiong [1 ,3 ]
Li, Jun [2 ]
Miao, Ji-Dong [1 ]
Li, Jia-Wei [1 ]
机构
[1] Zigong Fourth Peoples Hosp, Dept Oncol, Zigong 643000, Sichuan, Peoples R China
[2] Zigong Fourth Peoples Hosp, Dept Anesthesiol, Zigong 643000, Sichuan, Peoples R China
[3] Zigong Fourth Peoples Hosp, Dept Oncol, 19 Tanmulin Rd, Zigong 643000, Sichuan, Peoples R China
关键词
rectal cancer; neoadjuvant radiochemotherapy; surgery; meta-analysis; TOTAL MESORECTAL EXCISION; PREOPERATIVE CHEMORADIATION; ADJUVANT CHEMOTHERAPY; PHASE-II; CONCOMITANT CHEMORADIOTHERAPY; CONSOLIDATION CHEMOTHERAPY; PATHOLOGICAL RESPONSE; OPEN-LABEL; FOLLOW-UP; SURGERY;
D O I
10.1159/000534815
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Total neoadjuvant therapy (TNT) is a new strategy combining neoadjuvant therapy and chemotherapy to enhance tumor shrinkage and systemic control. Its effectiveness remains debated.Objectives: This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess TNT's impact and provide high-quality evidence for rectal cancer treatment decisions.Method: We searched China National Knowledge Infrastructure, VIP Database, Wanfang Database, China biomedical literature database, PubMed database, Embase database, and The Cochrane Library for RCTs comparing TNT with neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer. The included trials were screened and assessed for quality based on inclusion and exclusion criteria, and meta-analysis was performed using RevMan 5.3 software.Results: A total of 11 RCTs reported in 14 articles, with 1624 cases in the TNT group and 1541 cases in the CRT group. The results of the meta-analysis showed that compared with the CRT group, the TNT group had a higher pathological complete response rate (RR=1.65, 95% CI [1.40, 1.94], P<0.00001), higher T0 downstaging rate (RR=1.51, 95% CI [1.29, 1.77], P<0.00001), higher 3-year overall survival (HR=0.81, 95% CI [0.67, 0.98], P=0.03), and higher 3-year disease-free survival (HR=0.82, 95% CI [0.70, 0.95], P=0.008). However, there was no statistically significant difference between the two groups in terms of R0 resection rate (RR=1.02, 95% CI [0.99, 1.05], P=0.14), sphincter preservation rate (RR=0.94, 95% CI [0.88, 1.01], P=0.12), anastomotic leakage rate (RR=1.42, 95% CI [0.85, 2.38], P=0.18), and grade 3 or higher adverse events (RR=1.21, 95% CI [0.95, 1.54], P=0.13).Conclusions: In the treatment of locally advanced rectal cancer, TNT offers greater survival benefits compared to neoadjuvant CRT and does not significantly increase the incidence of adverse events. However, further data and studies with long-term outcomes are still required.
引用
收藏
页码:399 / 413
页数:15
相关论文
共 50 条
  • [41] Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview
    Guida, Andrea M.
    Sensi, Bruno
    Formica, Vincenzo
    D'Angelillo, Rolando M.
    Roselli, Mario
    Blanco, Giovanna Del Vecchio
    Rossi, Piero
    Capolupo, Gabriella T.
    Caricato, Marco
    Sica, Giuseppe S.
    BIOLOGY DIRECT, 2022, 17 (01)
  • [42] Different neoadjuvant therapies for locally advanced rectal cancer: A systematic review and network meta-analysis
    Petrelli, Fausto
    Trevisan, Francesca
    Tomasello, Gianluca
    De Stefani, Agostina
    Viti, Matteo
    Garrone, Ornella
    Luciani, Andrea
    Ghidini, Michele
    CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2022, 180
  • [43] Total neoadjuvant therapy for locally advanced rectal cancer A meaningful treatment option?
    Lauscher, Johannes
    Stintzing, Sebastian
    Boehmer, Dirk
    COLOPROCTOLOGY, 2022, 44 (04) : 221 - 228
  • [44] Is there a benefit of oxaliplatin in neoadjuvant treatment of locally advanced rectal cancer? An updated meta-analysis.
    Des Guetz, Gaetan
    Landre, Thierry
    Larrouy, Anne
    Panis, Yves
    Morere, Jean F.
    Mathonnet, Muriel
    Quero, Laurent
    JOURNAL OF CLINICAL ONCOLOGY, 2020, 38 (15)
  • [45] Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview
    Andrea M. Guida
    Bruno Sensi
    Vincenzo Formica
    Rolando M. D’Angelillo
    Mario Roselli
    Giovanna Del Vecchio Blanco
    Piero Rossi
    Gabriella T. Capolupo
    Marco Caricato
    Giuseppe S. Sica
    Biology Direct, 17
  • [46] Outcome of preoperative chemotherapy (POC) in locally advanced rectal cancer (LARC): Meta-analysis of randomized clinical trials (RCT)
    Tamburini, E.
    Tassinari, D.
    Papi, M.
    Oliverio, G.
    Nicoletti, S.
    Gianni, L.
    Poggi, B.
    Possenti, C.
    Drudi, F.
    Fattori, P.
    Ravaioli, A.
    JOURNAL OF CLINICAL ONCOLOGY, 2008, 26 (15)
  • [47] Fulvestrant in the treatment of advanced breast cancer: A systematic review and meta-analysis of randomized controlled trials
    Mauri, D.
    Valachis, A.
    Polyzos, N. P.
    Mavroudis, D.
    Georgoulias, V.
    Casazza, G.
    JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (15)
  • [48] Fulvestrant in the treatment of advanced breast cancer: A systematic review and meta-analysis of randomized controlled trials
    Valachis, Antonis
    Mauri, Davide
    Polyzos, Nikolaos P.
    Mavroudis, Dimitris
    Georgoulias, Vassilis
    Casazza, Giovanni
    CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2010, 73 (03) : 220 - 227
  • [49] The role of targeted agents in the treatment of advanced gastric cancer: a meta-analysis of randomized controlled trials
    Wang, C. -W.
    Fang, X. -H.
    EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 2016, 20 (09) : 1725 - 1732
  • [50] Effects of chemoradiotherapy and chemotherapy on survival of patients with locally advanced pancreatic cancer A meta-analysis of randomized controlled trials
    Wang, Cuiying
    Liu, Xiaohua
    Wang, Xiaohua
    Wang, Yanlei
    Cha, Na
    MEDICINE, 2018, 97 (36)