结肠癌的新辅助化疗：随机对照试验的系统回顾和荟萃分析

IF 7.6 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2025-04-25 DOI:10.1016/j.ejca.2025.115476

Mariana Macambira Noronha , Luiz F. Costa Almeida , Anelise Poluboiarinov Cappellaro , Luís Felipe Leite da Silva , Lucas Diniz da Conceição , Junior Samuel Alonso de Menezes , Marcos Belotto , Renata D.’Alpino Peixoto

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引用次数: 0

摘要

新辅助化疗（NAC）治疗已被视为一种有希望的替代术前手术，以提高非转移性结肠癌的疗效，但研究结果仍存在争议。考虑到这一持续的争论，我们对随机对照试验进行了系统回顾和荟萃分析，以评估NAC在高风险II期和III期结肠癌中的益处。材料和方法我们检索了PubMed、Embase和Cochrane，以获得评估NAC在非转移性结肠癌中的临床试验。采用Review Manager软件5.4版随机效应和固定效应模型进行统计分析。此外，为了评估异质性，采用I2统计量。结果共纳入4项临床试验1248例患者。NAC组显示死亡风险降低38% %。(HR 0.62;95 % ci 0.41-0.92；I2 = 0 %)，疾病复发风险降低21. % (HR 0.79；95 % ci 0.65-0.96；I2 = 0 %)。此外，NAC组的R0切除率更高，与术前相比，R0切除率增加了80% % (OR 1.80；95 % ci 1.24-2.61；I²= 0 %)。5.9达到病理完全缓解和主要病理反应（PCR）。% %和36.2 %。与总体人群相比，熟练错配修复的患者实现了更高的PCR率和复发风险的持续降低，比例分别为6.3% %和32% %。此外，NAC组的毒性谱也没有明显增加。结论我们的系统综述和荟萃分析支持新辅助化疗治疗高危II期和III期结肠癌的可行性和生存获益。

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Neoadjuvant chemotherapy for colon cancer: A systematic review and meta-analysis of randomized controlled trials

Introduction

Neoadjuvant chemotherapy (NAC) treatment has appeared as a promising alternative to upfront surgery to improve efficacy outcomes in non-metastatic colon cancer, but the findings are still controversial. Considering this ongoing debate, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the benefit of NAC in high-risk stage II and stage III colon cancer.

Materials and methods

We searched PubMed, Embase, and Cochrane for clinical trials evaluating NAC in non-metastatic colon cancer. Random and fixed effects models were employed for statistical analyses in Review Manager software version 5.4. Moreover, to evaluate the heterogeneity, I² statistics were used.

Results

A total of 1248 patients from 4 clinical trials were included. The NAC group demonstrated a 38 % reduction in the risk of death. (HR 0.62; 95 % CI 0.41–0.92; I² = 0 %), and a 21 % reduction in the risk of disease recurrence (HR 0.79; 95 % CI 0.65–0.96; I² = 0 %). Additionally, the NAC group had higher R0 resection, with an increase of 80 % in the odds compared to upfront surgery (OR 1.80; 95 % CI 1.24–2.61; I² = 0 %). Pathological complete response and major pathologic response (PCR) were achieved in 5.9.% % and 36.2 %, respectively. Patients with proficient mismatch repair achieved a higher PCR rate and a consistent reduction in the risk of recurrence compared to the overall population, with proportions of 6.3 % and 32 %, respectively. Also, there was no significant addition to the toxicity profile in the NAC arm.

Conclusion

Our systematic review and meta-analysis support the feasibility and survival benefits of neoadjuvant chemotherapy for high-risk stage II and III colon cancer.

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来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.