Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

作者全名："Yang, Jianguo; Deng, Qican; Cheng, Yong; Fu, Zhongxue; Wu, Xin"

作者地址："[Yang, Jianguo; Deng, Qican; Fu, Zhongxue; Wu, Xin] Chongqing Med Univ, Affiliated Hosp 3, Dept Gen Surg, Chongqing 401120, Peoples R China; [Cheng, Yong] Chongqing Med Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Chongqing 400016, Peoples R China"

通信作者："Wu, X (通讯作者)，Chongqing Med Univ, Affiliated Hosp 3, Dept Gen Surg, Chongqing 401120, Peoples R China."

来源：WORLD JOURNAL OF SURGICAL ONCOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001151287000001

JCR分区：Q1

影响因子：3.2

年份：2024

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Rectal cancer; Pathological complete response; Adjuvant chemotherapy; Overall survival

摘要："BackgroundLocally advanced rectal cancer is typically treated using a combination of neoadjuvant chemoradiotherapy and total mesorectal resection. While achieving pathological complete response following neoadjuvant chemoradiotherapy has been recognized as a positive prognostic factor in oncology, the necessity of adjuvant chemotherapy for locally advanced rectal cancer patients with pathological complete response after surgery remains uncertain. The objective of this meta-analysis was to examine the impact of adjuvant chemotherapy on the oncological outcomes of rectal cancer patients who attain pathological complete response after neoadjuvant chemoradiotherapy.MethodsThis meta-analysis followed the guidelines outlined in the preferred reporting items for systematic review and meta-analysis (PRISMA). The Web of Science, PubMed, and Cochrane Library databases were systematically searched to identify relevant literature.ResultsA total of 34 retrospective studies, including 9 studies from the NCBD database, involving 31,558 patients with pathological complete response rectal cancer, were included in the meta-analysis. The included studies were published between 2008 and 2023. The pooled analysis demonstrated that adjuvant chemotherapy significantly improved overall survival (HR = 0.803, 95% CI 0.678-0.952, P = 0.011), and no heterogeneity was observed (I2 = 0%). Locally advanced rectal cancer patients with pathological complete response who underwent adjuvant chemotherapy exhibited a higher 5-year overall survival rate compared to those who did not receive adjuvant chemotherapy (OR = 1.605, 95% CI 1.183-2.177, P = 0.002). However, the analysis also revealed that postoperative ACT did not lead to improvements in disease-free survival and recurrence-free survival within the same patient population. Subgroup analysis indicated that pathological complete response patients with clinical stage T3/T4, lymph node positivity, and younger than 70 years of age may benefit from adjuvant chemotherapy in terms of overall survival.ConclusionsThe findings of this meta-analysis suggest that adjuvant chemotherapy has a beneficial effect on improving overall survival among rectal cancer patients with pathological complete response. However, no such association was observed in terms of disease-free survival and recurrence-free survival."

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