Is Total Neoadjuvant Treatment Beneficial for Locally Advanced Rectal Cancer? A Meta-Analysis of Randomized Controlled Trials.

IF 2.5 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2024-01-01 Epub Date: 2023-11-03 DOI:10.1159/000534815

Hai-Qiong Wu, Jun Li, Ji-Dong Miao, Jia-Wei Li

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Abstract

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 TNTs 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 1,624 cases in the TNT group and 1,541 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 (risk ratio [RR] = 1.65, 95% confidence interval [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 (hazard ratio [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.

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全新辅助治疗对局部晚期癌症是否有益？随机对照试验的荟萃分析。

背景：全新辅助治疗（TNT）是新辅助治疗和化疗相结合的一种新策略，旨在增强肿瘤缩小和系统控制。其有效性仍存在争议。目的：本研究对随机对照试验（RCTs）进行了荟萃分析，以评估TNT的影响，并为癌症治疗决策提供高质量的证据。方法：检索中国国家知识基础设施、VIP数据库、万方数据库、中国生物医学文献数据库、PubMed数据库、Embase数据库和The Cochrane图书馆，比较TNT与新辅助放化疗（CRT）治疗局部晚期癌症的随机对照试验。根据纳入和排除标准对纳入的试验进行质量筛选和评估，并使用RevMan 5.3软件进行荟萃分析。结果：在14篇文章中共报道了11例随机对照试验，其中TNT组1624例，CRT组1541例。荟萃分析结果表明，与CRT组相比，TNT组具有较高的病理完全缓解率（RR=1.65，95%CI[1.40，1.94]，P结论：在治疗局部晚期癌症时，与新辅助CRT相比，TNT提供了更大的生存益处，并且不会显著增加不良事件的发生率。然而，仍需进一步的数据和长期结果研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.